The Urban Youth Trauma Center: A Trauma-Informed Continuum for Addressing Community Violence Among Youth.

Contemporary community violence has escalated into a national public health crisis with urban youth, particularly ethnic minorities, suffering disproportionate negative impacts. The Urban Youth Trauma Center (UYTC) promotes a trauma-informed continuum of prevention-to-intervention services that combines community-based and clinic-based manualized protocols designed to reduce and prevent community violence for youth and families. Based on a socio-ecological model, UYTC has the main goals of addressing community violence and related traumatic stress as well as co-occurring conditions of substance abuse and disruptive behavior problems in urban youth by: (1) raising public awareness; (2) disseminating specialized trauma-informed training; and (3) mobilizing service system coalitions. UYTC employs this evidence-based yet flexible structure for disseminating, implementing, and evaluating trauma-informed training as a means of contributing to the reduction and prevention of community violence for low-income urban minority youth and families who bear the biggest burden of this current crisis.

Psychometric properties of the Community Violence-Prevention Activation Measure (CV-PAM): Evaluating provider activation toward community violence prevention.

This study reports on the conceptualization of activation, and the development and psychometrics of the Community Violence-Prevention Activation Measure (CV-PAM). The CV-PAM was adapted from the Patient Activation Measure (PAM; Hibbard et al., 2004, Health Serv Res, 39, 1005-1026; Hibbard et al., 2005, Health Serv Res, 40, 1918-1930) for use among a workforce servicing youth exposed to community violence. Activation toward community violence prevention is defined as a process in which community members are activated to prevent violence, believe they have important roles to play in violence prevention and supporting the well-being of community members. Activated community members have a good understanding of the factors that contribute to violence and they apply skills and strategies that are consistent with prevention efforts. Six hundred and ninety-four youth providers completed the 18-item CV-PAM to describe their level of activation toward community violence. Exploratory and confirmatory factor analyses were performed and demonstrated that a three factor versus a four factor structure of activation (modeled after PAM) held together. The three factors included (a) belief that an active role is important to address community violence; (b) having the confidence and knowledge to take action around community violence prevention; (c) taking action: frequency of participation and responsiveness to community needs. The proposed fourth factor, staying the course under stress, did not have any qualifying loadings, and thus, could not be interpreted. CV-PAM performed well in tests of reliability and validity. The CV-PAM appears to be a precise, valid, reliable, and useful measure. Implications suggest that using this tool is potentially the first step toward understanding activation among engaged providers and a stepping stone toward increased involvement in community violence prevention through implementation and dissemination efforts.

Supporting the need for an integrated system of care for youth with co-occurring traumatic stress and substance abuse problems.

Adolescents are at high risk for violence exposure and initiation of drug use. Co-occurring substance use and trauma exposure are associated with increased risk of mental health disorders, school underachievement, and involvement with multiple systems of care. Coordination and integration of systems of care are of utmost importance for these vulnerable youth. This study delineates the negative sequelae and increased service utilization patterns of adolescents with a history of trauma, substance abuse, and co-occurring trauma and substance abuse to support the need for integrated mental health and substance abuse services for youth. Data from two national sources, the National Child Traumatic Stress Network and Center for Substance Abuse Treatment demonstrate the increased clinical severity (measured by reports of emotional and behavioral problems), dysfunction, and service utilization patterns for youth with co-occurring trauma exposure and substance abuse. We conclude with recommendations for an integrated system of care that includes trauma-informed mental health treatment and substance abuse services aimed at reducing the morbidity and relapse probability of this high-risk group.

Prevalence and Correlates of Childhood-Onset Anxiety Disorders among Latinos and Non-Latino Whites in the United States.

Anxiety disorders are the most prevalent class of psychiatric disorders (Kessler, et al., 2005) and their early onset places individuals at risk for a wide range of subsequent problems (Weissman, et al., 1999). Data from the National Latino and Asian American Study (NLAAS) and the National Comorbidity Survey-Replication (NCS-R) were used to investigate the prevalence and correlates of childhood-onset anxiety disorders among U.S.-born whites, U.S.-born Latinos, and foreign-born Latinos. Significant differences in rates of childhood-onset anxiety disorders were found, with foreign-born Latinos reporting the lowest rates. Across all three ethnicity/nativity groups, individuals with childhood-onset anxiety disorders had equal or higher levels of past-year impairment, relative to individuals with adult-onset anxiety disorders. The chronic course associated with childhood-onset anxiety disorders was also revealed to be present regardless of ethnicity and nativity, as indicated by the similarities across groups in the mean number of lifetime disorders and comorbidity rates. Treatment and assessment recommendations are discussed with respect to the findings.

Identification of high-risk behaviors among victimized adolescents and implications for empirically supported psychosocial treatment.

An adolescent's possible response to being the victim of interpersonal violence is not limited to posttraumatic stress disorder and depression but may also involve a host of developmental effects, including the occurrence of high-risk behaviors that may have a significant and negative impact on the adolescent's psychological and physical health. Identifying such high-risk behaviors, understanding their possible link to a previous victimization incident, and implementing interventions that have been demonstrated to reduce such behaviors may help decrease potential reciprocal interactions between these areas. Clinicians in psychiatric practice may be in a unique position to make these connections, since parents of adolescents may perceive a greater need for mental health services for youth engaging in problematic externalizing behaviors than for those displaying internalizing symptoms. In this article, the authors first describe high-risk behaviors, including substance use, delinquent behavior, risky sexual behaviors, and self-injurious behaviors, that have been linked with experiencing interpersonal violence. They then review empirically based treatments that have been indicated to treat these deleterious behaviors in order to help clinicians select appropriate psychosocial interventions for this population. Recommendations for future research on the treatment of high-risk behaviors in adolescents are also presented.

Prevalence and correlates of childhood-onset anxiety disorders among Latinos and non-Latino whites in the United States / /Prevalencia y correlación del inicio de los trastornos de ansiedad en la infancia entre blancos latinos y no latinos en los Estados Unidos

Los trastornos de ansiedad son los trastornos psiquiátricos más comunes (Kessler et al., 2005) y su comienzo a temprana edad pone a las personas en riesgo de una gran variedad de problemas posteriores (Weissman et al., 1999). Se utilizaron los datos del Estudio Nacional de Latinos y Asiáticos Americanos (National Latino and Asian American Study, NLAAS) y de la Replicación de la Encuesta Nacional de Comorbilidad (National Comorbidity Survey-Replication, NCS-R) para investigar la prevalencia y los factores asociados con el inicio de la ansiedad en la infancia entre los blancos nacidos en Estados Unidos, Latinos nacidos en Estados Unidos y Latinos nacidos en el extranjero. Se encontraron diferencias significativas en las tasas del trastorno por ansiedad con inicio en la infancia, con las tasas más bajas en los Latinos nacidos en el extranjero. En los tres grupos de etnia/lugar de nacimiento, los individuos con trastornos de ansiedad con inicio en la infancia mostraron niveles similares o más elevados de deterioro en el año anterior que los individuos con trastornos de ansiedad con inicio en la adultez. También se mostró el curso crónico asociado con los trastornos de ansiedad de comienzo en la infancia, pues estuvo presente sin importar la etnia o el lugar de nacimiento, indicado por las semejanzas a través de los grupos en el número promedio de trastornos a lo largo de la vida y las tasas de comorbilidad. Se discuten recomendaciones para la evaluación y el tratamiento con respecto a los hallazgos del estudio (AU)

Anxiety disorders are the most prevalent class of psychiatric disorders (Kessler et al., 2005) and their early onset places individuals at risk for a wide range of subsequent problems (Weissman et al., 1999). Data from the National Latino and Asian American Study (NLAAS) and the National Comorbidity Survey-Replication (NCS-R) were used to investigate the prevalence and correlates of childhood-onset anxiety disorders among U.S.-born whites, U.S.-born Latinos, and foreign-born Latinos. Significant differences in rates of childhood-onset anxiety disorders were found, with foreign-born Latinos reporting the lowest rates. Across all three ethnicity/nativity groups, individuals with childhood-onset anxiety disorders had equal or higher levels of past-year impairment, relative to individuals with adult-onset anxiety disorders. The chronic course associated with childhood-onset anxiety disorders was also revealed to be present regardless of ethnicity and nativity, as indicated by the similarities across groups in the mean number of lifetime disorders and comorbidity rates. Treatment and assessment recommendations are discussed with respect to the findings