Youth violence across multiple dimensions: a study of violence, absenteeism, and suspensions among middle school children.

OBJECTIVE: To determine how multidimensional measures of violence correlate with school absenteeism and suspensions among middle school youth. STUDY DESIGN: A cross-sectional survey was conducted in 2004 with 28 882 sixth graders from an urban school district. Data were collected on role (witness, victim, perpetrator) and mode (verbal, physical, weapons) of past-year violence exposures, and absences and suspensions over 1 academic year. Associations between violence and absenteeism and suspension were estimated using generalized linear models. RESULTS: ORs for suspension increased from witnessing to victimization to perpetration and then victimization-perpetration. Among those exposed to weapons, victims (OR(boys) = 1.45; OR(girls) = 1.38) had similar or slightly higher ORs for absenteeism than perpetrators (OR(boys) = 1.39; OR(girls) = 1.17). Boy victims and witnesses of physical violence had similar absenteeism patterns as those unexposed to physical violence. Of all exposed girls, victim-perpetrators had the highest ORs for absenteeism (OR = 1.76). CONCLUSION: Exposure to violence correlated with absenteeism and suspension. The strength of these relationships depended on mode and role in exposure. Our cross-sectional data limits our ability to establish causality. Findings have implications for prevention.

Regional Research-Practice-Policy Partnerships in Response to Climate-Related Disparities: Promoting Health Equity in the Pacific.

Although climate change poses a threat to health and well-being globally, a regional approach to addressing climate-related health equity may be more suitable, appropriate, and appealing to under-resourced communities and countries. In support of this argument, this commentary describes an approach by a network of researchers, practitioners, and policymakers dedicated to promoting climate-related health equity in Small Island Developing States and low- and middle-income countries in the Pacific. We identify three primary sets of needs related to developing a regional capacity to address physical and mental health disparities through research, training, and assistance in policy and practice implementation: (1) limited healthcare facilities and qualified medical and mental health providers; (2) addressing the social impacts related to the cooccurrence of natural hazards, disease outbreaks, and complex emergencies; and (3) building the response capacity and resilience to climate-related extreme weather events and natural hazards.

Effects on school outcomes in low-income minority youth: preliminary findings from a community-partnered study of a school-based trauma intervention.

OBJECTIVE: To examine academic outcomes of a community-partnered school mental health intervention for students exposed to community violence. DESIGN: Randomized controlled trial. SETTING AND PARTICIPANTS: Sixth-grade students (N = 123) from 2 middle schools in Los Angeles during the 2001-2002 academic year who had exposure to violence and posttraumatic stress symptoms in the clinical range. INTERVENTION: Students were randomized to either receive a 10-session standardized school trauma intervention (Cognitive Behavioral Intervention for Trauma in Schools) soon after screening (early intervention) or after a delay following screening (delayed intervention), but within the same school year. MAIN OUTCOME MEASURES: 59 students in the early intervention group vs. 64 students in the delayed intervention group (screened in September or December) were compared on spring semester grades in math and language arts, controlling for the students' standardized state test scores from the previous academic year and other covariates. RESULTS: Students in the early intervention group had a significantly higher spring semester mean grade in math (2.0 vs 1.6) but not language arts (2.2 vs 1.9). Students in the early intervention group were more likely than students in the delayed intervention group to have a passing grade (C or higher) in language arts (80% vs 61%; P < .033) by spring semester; we also found a substantial difference in the number of students receiving a passing math grade (70% vs 55%; P = .053). CONCLUSION: Through a collaborative partnership between school staff and researchers, preliminary evidence suggests that receiving a school trauma intervention soon after screening compared to delaying treatment can result in better school grades.

Global climate change and mental health.

Although several empirical studies and systematic reviews have documented the mental health impacts of global climate change, the range of impacts has not been well understood. This review examines mental health impacts of three types of climate-related events: (1) acute events such as hurricanes, floods, and wildfires; (2) subacute or long-term changes such as drought and heat stress; and (3) the existential threat of long-lasting changes, including higher temperatures, rising sea levels and a permanently altered and potentially uninhabitable physical environment. The impacts represent both direct (i.e. heat stress) and indirect (i.e. economic loss, threats to health and well-being, displacement and forced migration, collective violence and civil conflict, and alienation from a degraded environment) consequences of global climate change.

Strategies for Delivering Mental Health Services in Response to Global Climate Change: A Narrative Review.

This narrative review examined strategies for preparedness and response to mental health impacts of three forms of climate change from a services perspective: (1) acute and extreme weather events such as hurricanes, floods, and wildfires, (2) sub-acute or long-term events such as droughts and heatwaves; and (3) the prospect of long-term and permanent changes, including higher temperatures, rising sea levels, and an uninhabitable physical environment. Strategies for acute events included development and implementation of programs and practices for monitoring and treating mental health problems and strengthening individual and community resilience, training of community health workers to deliver services, and conducting inventories of available resources and assessments of at-risk populations. Additional strategies for sub-acute changes included advocacy for mitigation policies and programs and adaptation of guidelines and interventions to address the secondary impacts of sub-acute events, such as threats to livelihood, health and well-being, population displacement, environmental degradation, and civil conflict. Strategies for long-lasting changes included the implementation of evidence-based risk communication interventions that address the existing and potential threat of climate change, promoting the mental health benefits of environmental conservation, and promoting psychological growth and resilience.

Accountability and assessment of emergency drill performance at schools.

Many schools throughout the United States are mandated to hold drills, or operational exercises, to prepare for fires, earthquakes, violence, and other emergencies. However, drills have not been assessed for their effectiveness in improving preparedness at schools. This mixed-methods study measures the quantity and the quality of drills in an urban school district in Los Angeles. Compliance with California mandates was fair; most schools barely met requirements. Drills were not used as opportunities to improve procedures. Sites neither conducted any self-assessments nor made changes to procedures on the basis of performance. Suggestions include developing realistic simulated exercises, debriefing, and better school accountability for drills.

Improving adjustment and resilience in children following a disaster: Addressing research challenges.

There is compelling evidence of the potential negative effects of disasters on children's adjustment and functioning. Although there is an increasing base of evidence supporting the effectiveness of some interventions for trauma following disaster, more research is needed, particularly on interventions that can be delivered in the early aftermath of disaster as well as those that can address a broader range of adjustment difficulties such as bereavement that may be experienced by children after a disaster. This article identifies gaps in the knowledge of how best to intervene with children following disasters. Key challenges in conducting research in disaster contexts, including obtaining consent, designing rigorous studies, and obtaining funding quickly enough to conduct the study, are discussed. Several strategies hold promise to address research challenges in disasters, including using alternative designs (e.g., propensity scores, matched control groups, group-level assignment), working with schools and communities, and studying implementation of nontraditional modes of intervention delivery. (PsycINFO Database Record

Who gets care? Mental health service use following a school-based suicide prevention program.

OBJECTIVE: To examine symptomatology and mental health service use following students' contact with a large urban school district's suicide prevention program. METHOD: In 2001 school district staff conducted telephone interviews with 95 randomly selected parents approximately 5 months following their child's contact with the district's suicide prevention program, a School Gatekeeper Training model. Parents provided information regarding service use, their child's depressive symptoms (using the Diagnostic Interview Schedule for Children Predictive Scale, Depression module), and their perceptions of their child's need for services. Information about the crisis intervention was abstracted from a standardized assessment form. RESULTS: More than two thirds of students received school or community mental health services following contact with the suicide prevention program. Depressive symptoms, but not past year suicide attempt, predicted community mental health service use. Latino students had lower rates of community mental health service use than non-Latinos. School-based service use did not differ by student characteristics including race/ethnicity. CONCLUSIONS: Most students identified by a school-based suicide prevention program received follow-up care, although Latinos were less likely to access services outside the school. School-based mental health services may be an important way in which underserved populations at risk of suicide can receive care.

Active parental consent for a school-based community violence screening: comparing distribution methods.

BACKGROUND: Students are unable to benefit from many school programs designed to address their mental health needs if their parents do not consent to their participation. As part of an ongoing effort in a large urban school district to meet the mental health needs of students traumatized by violence exposure, this paper examines the impact of alternative approaches on parental response and consent rates for an initial screening to participate in a school mental health program. METHODS: Two alternative approaches were used to obtain consent for students to participate in a school-based intervention for students exposed to violence. For one cohort, consent forms were distributed along with school information and other school forms during a parent orientation meeting. In the other cohort, school mental health clinicians visited student homerooms to distribute consent forms and explain the program and evaluation to students. RESULTS: There were significantly higher rates of return of consent forms (89.8% vs 53.2%) and parents consenting to participate (69.6% vs 27.9%) among parents receiving consent forms at a school meeting than among parents whose forms were distributed to children in a classroom, with comparable rates of active refusals to participate (20.1% vs 25.3%). CONCLUSIONS: Overall return rates and rates of consent for screening participation were substantially higher when the consent form and accompanying materials were provided directly to parents rather than distributed in the classroom and sent home with students. These findings have implications for efforts to obtain active consent from parents for students to participate in school mental health programs.

Building an academic-community partnered network for clinical services research: the Community Health Improvement Collaborative (CHIC).

OBJECTIVE: Community-based participatory research is recommended for research on health disparities and to improve uptake of clinical research findings. We describe the development of a multicenter consortium designed to support a community agency-academic partner infrastructure to support community-based, health-services research on multiple sources of health and healthcare disparities in local communities. DESIGN: We describe the development of the Los Angeles Community Health Improvement Collaborative (CHIC). RESULTS: The CHIC partners examined the research capacity and health priorities of its partners and developed a research agenda focused on four tracer conditions (depression, violence, diabetes, and obesity) and four areas for development of research capacity: public participation in all phases of research; understanding community and organizational context for clinical services interventions; practical clinical services trial methods; and advancing health information technology for clinical services research. The partners pooled resources to develop these areas for the tracer conditions. CONCLUSIONS: The challenges of a participatory approach to community-based clinical services research go beyond the significant methodologic and operational issues for specific projects and include building a sustainable capacity for research, community programs, and partnership across diverse communities and stakeholder organizations even when funding sources are not fully aligned with these goals.

Preventing secondary traumatic stress in educators.

Teachers can be vulnerable to secondary traumatic stress (STS) because of their supportive role with students and potential exposure to students' experiences with traumas, violence, disasters, or crises. STS symptoms, similar to those found in posttraumatic stress disorder, include nightmares, avoidance, agitation, and withdrawal, and can result from secondary exposure to hearing about students' traumas. This article describes how STS presents, how teachers can be at risk, and how STS can manifest in schools. A US Department of Education training program is presented, and thoughts on future directions are discussed.

A school-based mental health program for traumatized Latino immigrant children.

OBJECTIVE: To pilot-test a school mental health program for Latino immigrant students who have been exposed to community violence. METHOD: In this quasi-experimental study conducted from January through June 2000, 198 students in third through eighth grade with trauma-related depression and/or posttraumatic stress disorder symptoms were compared after receiving an intervention or being on a waitlist. The intervention consisted of a manual-based, eight-session, group cognitive-behavioral therapy (CBT) delivered in Spanish by bilingual, bicultural school social workers. Parents and teachers were eligible to receive psychoeducation and support services. RESULTS: Students in the intervention group ( = 152) had significantly greater improvement in posttraumatic stress disorder and depressive symptoms compared with those on the waitlist ( = 47) at 3-month follow-up, adjusting for relevant covariates. CONCLUSIONS: A collaborative research team of school clinicians, educators, and researchers developed this trauma-focused CBT program for Latino immigrant students and their families. This pilot test demonstrated that this program for traumatized youths, designed for delivery on school campuses by school clinicians, can be implemented and evaluated in the school setting and is associated with a modest decline in trauma-related mental health problems.

Violence exposure, posttraumatic stress disorder, and depressive symptoms among recent immigrant schoolchildren.

OBJECTIVE: Many recent immigrant children are at risk for violence exposure and related psychological distress resulting from experiences before, during, and after immigration. This study examines the rates of violence exposure and associated symptoms among recent immigrant children in Los Angeles. METHOD: 1,004 recent immigrant schoolchildren (aged 8-15 years) were surveyed about their prior exposure to violence and symptoms of posttraumatic stress disorder (PTSD) and depression. Participants included children whose native language was Spanish, Korean, Russian, or Western Armenian. RESULTS: Participants reported high levels of violence exposure, both personal victimization and witnessing violence, in the previous year and in their lifetimes. Thirty-two percent of children reported PTSD symptoms in the clinical range, and 16% reported depressive symptoms in the clinical range. Although boys and older children were more likely to have experienced violence, girls reported more PTSD and depressive symptoms. Linear multiple regressions revealed that PTSD symptoms were predicted by both recent and lifetime violence exposure (p values < .001 and p < .05, respectively), when depressive symptoms and gender were controlled. On the other hand, depressive symptoms were predicted by recent victimization only (p < .001) when PTSD and gender were controlled. CONCLUSION: These findings document the need for interventions addressing the psychological sequelae of violence exposure in immigrant children.

Theoretical basis and program design of a school-based mental health intervention for traumatized immigrant children: a collaborative research partnership.

This article describes a collaborative research model for school-based mental health services that targets children who are recent immigrants with violence-related mental health symptoms. The model describes a conceptual framework used in the establishment of an academic-community partnership during the development, evaluation, and implementation of the Mental Health for Immigrants Program (MHIP), a school-based mental health intervention. The article discusses the challenges that occurred and provides specific examples of how a participatory research partnership may work together through all program phases--design through implementation and program evaluation--to meet a specific community's needs and produce generalizable knowledge. The challenges and limitations of collaborative research approaches also are discussed, with particular emphasis on the role of participatory research in the development and evaluation of school-based mental health programs.

A mental health intervention for schoolchildren exposed to violence: a randomized controlled trial.

CONTEXT: No randomized controlled studies have been conducted to date on the effectiveness of psychological interventions for children with symptoms of posttraumatic stress disorder (PTSD) that has resulted from personally witnessing or being personally exposed to violence. OBJECTIVE: To evaluate the effectiveness of a collaboratively designed school-based intervention for reducing children's symptoms of PTSD and depression that has resulted from exposure to violence. DESIGN: A randomized controlled trial conducted during the 2001-2002 academic year. SETTING AND PARTICIPANTS: Sixth-grade students at 2 large middle schools in Los Angeles who reported exposure to violence and had clinical levels of symptoms of PTSD. INTERVENTION: Students were randomly assigned to a 10-session standardized cognitive-behavioral therapy (the Cognitive-Behavioral Intervention for Trauma in Schools) early intervention group (n = 61) or to a wait-list delayed intervention comparison group (n = 65) conducted by trained school mental health clinicians. MAIN OUTCOME MEASURES: Students were assessed before the intervention and 3 months after the intervention on measures assessing child-reported symptoms of PTSD (Child PTSD Symptom Scale; range, 0-51 points) and depression (Child Depression Inventory; range, 0-52 points), parent-reported psychosocial dysfunction (Pediatric Symptom Checklist; range, 0-70 points), and teacher-reported classroom problems using the Teacher-Child Rating Scale (acting out, shyness/anxiousness, and learning problems; range of subscales, 6-30 points). RESULTS: Compared with the wait-list delayed intervention group (no intervention), after 3 months of intervention students who were randomly assigned to the early intervention group had significantly lower scores on symptoms of PTSD (8.9 vs 15.5, adjusted mean difference, - 7.0; 95% confidence interval [CI], - 10.8 to - 3.2), depression (9.4 vs 12.7, adjusted mean difference, - 3.4; 95% CI, - 6.5 to - 0.4), and psychosocial dysfunction (12.5 vs 16.5, adjusted mean difference, - 6.4; 95% CI, -10.4 to -2.3). Adjusted mean differences between the 2 groups at 3 months did not show significant differences for teacher-reported classroom problems in acting out (-1.0; 95% CI, -2.5 to 0.5), shyness/anxiousness (0.1; 95% CI, -1.5 to 1.7), and learning (-1.1, 95% CI, -2.9 to 0.8). At 6 months, after both groups had received the intervention, the differences between the 2 groups were not significantly different for symptoms of PTSD and depression; showed similar ratings for psychosocial function; and teachers did not report significant differences in classroom behaviors. CONCLUSION: A standardized 10-session cognitive-behavioral group intervention can significantly decrease symptoms of PTSD and depression in students who are exposed to violence and can be effectively delivered on school campuses by trained school-based mental health clinicians.

School intervention related to school and community violence.

Schools are well positioned to facilitate recovery for students exposed to community or school violence or other traumatic life events affecting populations of youth. This article describes how schools can circumvent several key barriers to mental health service provision, outcomes that school interventions target, and the role of the family in school-based services. It includes a description of the history of schools in facilitating recovery for students exposed to traumatic events, particularly related to crisis intervention, and the current status of early intervention and strategies for long-term recovery in the school setting. Challenges and future directions are also discussed.

A web-based platform to support an evidence-based mental health intervention: lessons from the CBITS web site.

OBJECTIVE: To explore the role of Web-based platforms in behavioral health, the study examined usage of a Web site for supporting training and implementation of an evidence-based intervention. METHODS: Using data from an online registration survey and Google Analytics, the investigators examined user characteristics and Web site utilization. RESULTS: Site engagement was substantial across user groups. Visit duration differed by registrants' characteristics. Less experienced clinicians spent more time on the Web site. The training section accounted for most page views across user groups. Individuals previously trained in the Cognitive-Behavioral Intervention for Trauma in Schools intervention viewed more implementation assistance and online community pages than did other user groups. CONCLUSIONS: Web-based platforms have the potential to support training and implementation of evidence-based interventions for clinicians of varying levels of experience and may facilitate more rapid dissemination. Web-based platforms may be promising for trauma-related interventions, because training and implementation support should be readily available after a traumatic event.

Listen protect connect for traumatized schoolchildren: a pilot study of psychological first aid.

BACKGROUND: Listen Protect Connect (LPC), a school-based program of Psychological First Aid delivered by non-mental health professionals, is intended to support trauma-exposed children. Our objective was to implement LPC in a school setting and assess the effectiveness of LPC on improving psychosocial outcomes associated with trauma. METHODS: A pilot quasi-experiment was conducted with middle school children self-identified or referred to the school nurse as potentially exposed to stressful life experiences. LPC was provided to students by the school nurse, and questionnaires were administered at baseline, 2-, 4- and 8-weeks to assess life stressors, symptoms of post-traumatic stress disorder and depression, social support, and school connectedness. A total of 71 measurements were collected from 20 children in all. Although a small sample size, multiple measurements allowed for multivariable mixed effects models to analyze changes in the repeated outcomes over time. RESULTS: Students who received the intervention had reduced depressive and posttraumatic stress symptoms from baseline throughout follow-up period. Total social support also increased significantly from baseline through 8-weeks, and school connectedness increased up to 4-weeks post-intervention. CONCLUSIONS: This study demonstrates the potential of LPC as a school-based intervention of Psychological First Aid. Future randomized trials of LPC are needed, however.

Responding to students with posttraumatic stress disorder in schools.

The prevalence of trauma exposure among youth is a major public health concern. Students who have experienced a traumatic event are at increased risk for academic, social, and emotional problems. School can be an ideal setting for mental health professionals to intervene with traumatized students, school staff, and parents both immediately following a traumatic event and when symptoms of posttraumatic stress disorder and other trauma-related mental health problems develop. This article describes evidence-based treatments for posttraumatic stress disorder and outlines practical approaches to use in schools.