Interventions for adult survivors of intrafamilial homicide: A review of the literature.

Individuals bereaved by intrafamilial homicide, in which the perpetrator and decedent were both members of the same family, experience an elevated risk for risk for mental health complications. Given the contextual complexity of intrafamilial homicide (IFH) and the negative sequalae this form of loss can engender, psychological interventions may assist survivors with adjustment on a number of fronts. This scoping review therefore addresses an important knowledge gap by summarizing the limited information on interventions specific to intrafamilial homicide survivors. Results failed to identify interventions specific to IFH bereavement, though interventions that may be deemed appropriate are highlighted and described. As such, this scoping review provides a practical synthesis of evidence-based and evidence-informed psychological interventions for traumatic loss that are applicable to and may hold promise for this vulnerable population. Recommendations for future research and best practices with intrafamilial homicide survivors are also discussed.

Moving toward transdisciplinary approaches to addressing HIV and psychological trauma: Barriers and facilitators to building collaborations.

Most people living with HIV have experienced potentially traumatic events (e.g., physical assault, sexual assault, intimate partner violence) and, consequently, are at risk of trauma-related mental health difficulties, including posttraumatic stress disorder (PTSD). Yet, research and clinical efforts related to HIV and psychological trauma remain siloed. Guided by the four-phase model of transdisciplinary research, the current study explored barriers and facilitators to transdisciplinary HIV/trauma clinical and research collaborations to address the overlap between HIV and psychological trauma. This exploration represents an initial step in the development and conceptualization of a transdisciplinary team known as Team REACH (Resiliency, Engagement, and Accessibility for Comorbid HIV/PTSD), which seeks to address the overlap between HIV and psychological trauma. Barriers and facilitators were explored through individual qualitative interviews with 21 research and clinical staff members across two clinics within an academic medical center (i.e., an infectious diseases clinic and a trauma-focused specialty mental health clinic). The findings revealed a number of barriers, including a lack of awareness, time and funding concerns, and a lack of clarity regarding services or the division of responsibility. The results also highlight perceived facilitators for collaborations, such as existing infrastructure and relationships, shared goals, leadership support, knowledge of other agency activities, and staff/team buy-in. Recommendations for increased collaboration included ongoing communication, needs assessment and goal development, access to partners, and role establishment. These findings will guide the next steps in further developing transdisciplinary collaboration goals and have implications for increasing collaborative approaches to patient care and targeting processes to enhance team effectiveness for transdisciplinary goals.

Interpersonal Violence, PTSD, and Substance Use Types among Women Receiving Substance Use Treatment.

Objective: Many women receiving substance use treatment report histories of interpersonal violence (IV) victimization, including physical and sexual assault. IV is a risk factor for mental and behavioral health difficulties such as posttraumatic stress disorder (PTSD) and substance use disorder (SUD). Consistent with the self-medication hypothesis, PTSD may explain elevated SUD among IV survivors. Yet, few studies have investigated whether PTSD may have differential mediating effects for different substances, which has significant treatment implications. Methods: In 124 women (M age = 35.37, SD = 11.90) in substance use treatment, we examined PTSD symptoms as a mediator between IV and severity of different types of substance use, including alcohol, cannabis, cocaine, and opioid use. Participants completed self-report measures including the ASSIST, PCL-5, and LEC-5. Data were analyzed using path analysis in Mplus 8.3. Both dichotomous and continuous outcomes of problematic substance use outcomes were examined. Results: Most women (53.3%) reported problematic substance use with at least one substance, including opioids (39.7%), cocaine (13.0%), alcohol (9.6%), and cannabis (5.6%). Most (83.2%) of the sample reported at least one IV incident. On average, women reported clinically significant PTSD symptom severity. When problematic substance use was examined dichotomously, findings revealed significant indirect effects from IV exposure to opioid (ß = 0.10, p = .010) and cocaine use (ß = 0.07, p = .039) via elevated PTSD symptoms. There were no significant indirect effects for problematic alcohol (ß = 0.03, p = .260) or cannabis use (ß = 0.02, p = .562). When substance use was examined continuously, results revealed significant indirect effects from IV exposure to opioid (ß = 0.09, p = .017), cocaine use (ß = 0.09, p = .015), and alcohol use (ß = 0.08, p = .020) via elevated PTSD symptoms. Indirect effects for cannabis use remained nonsignificant (ß = 0.05, p = .100). Conclusions: IV survivors may be particularly at risk for opioid and cocaine misuse because of elevated PTSD symptoms. Treatments that integrate PTSD and SUD are needed to simultaneously target traumatic stress and substance use. Women with opioid and cocaine misuse may particularly benefit from trauma-focused exposure-based psychotherapy to reduce symptoms of PTSD, and thus, decrease opioid and cocaine misuse.

Interventions for child and adolescent survivors of intrafamilial homicide: A review of the literature.

The nature of intrafamilial homicide is complex and traumatic. Child survivors are at significant risk for maladjustment, including negative psychological sequela, grief complications, and contextual challenges associated with the homicide. Thus, children may benefit from services addressing specific psychosocial challenges following intrafamilial homicide. In this paper, we review the literature to identify trauma- and grief-informed interventions implemented for youth following violent bereavement. Given limited research on this vulnerable population, we discuss interventions that show promise for child survivors, exploring specific needs, challenges, and potential implications of these interventions for treating children and families experiencing intrafamilial homicide bereavement.

Substance Use Prevention Programming for Adolescents and Young Adults: A Mixed-Method Examination of Substance Use Perceptions and Use of Prevention Services.

BACKGROUND: Although substance use problems are highly prevalent among adolescents and emerging adults, this population does not regularly receive substance use prevention programming in their communities. Low perceived risk of substance use, which is linked to actual behavior, may contribute to low rates of engagement in community prevention efforts for substance use. To examine this, the current study used a mixed methods approach to: (1) examine the relationship between engagement in prevention education and substance use; and, (2) analyze qualitative data on education programs offered in the community to help identify strengths and gaps in prevention resources. Method: Quantitative and qualitative data were collected from adolescents (age 13-18) and young adults (age 19-25) living in the Southeast, recruited from local schools and community events to participate in a preventive intervention focused on prevention of HIV, substance use, and other risky behaviors. Prior to engagement in this intervention, self-report questionnaires were completed by adolescents assessing: substance use, perceived risk, and engagement in substance use education classes. Focus groups were also conducted with adolescents recruited from a local high school and young adults recruited from local colleges to obtain additional information about engagement in education programs. Results: Regarding perceived risk, 71.8% of adolescents reported moderate to great risk in having five or more drinks once or twice a week and 43% of adolescents reported moderate to great risk in smoking cannabis once or twice a week. Forty-four percent of adolescents had talked to one of their parents about the dangers of tobacco, alcohol, or drug use in the past year. Further, 18% of adolescents had been to a class or program on prevention of alcohol and other drug abuse in the past month and 50.7% had heard, read, or watched an advertisement about prevention of substance use in the past year. Qualitative results Eight overarching themes, each with its own sub-themes, emerged from the participant's responses during the focus groups. Each is described below with representative quotes provided throughout for illustrative purposes. Conclusions: Findings revealed several gaps in resources identified by adolescents and young adults that are needed to adequately address substance use, which provide important next steps for substance use prevention among youth.

Enhancing the Delivery of an Empirically-Supported Trauma-Focused Treatment for Adolescents: Providers' Views of the Role of Technology and Web-Based Resources.

This mixed-methods study assessed providers' views of the use of technology in the delivery of an empirically supported mental health treatment for adolescents (Trauma-Focused Cognitive Behavioral Therapy; TF-CBT). Thematic qualitative interviews were conducted with nine experienced providers. Emerging themes served as the basis for the creation of a quantitative web-based survey, completed by 56 TF-CBT experts, to assess the perceived helpfulness of the recommendations. Technology was perceived as a useful, appealing, and familiar tool that could greatly enhance the delivery of this treatment modality with adolescents. Main recommendations included the creation of a mobile application targeting all of the treatment components and a website with developmentally appropriate resources for providers, caregivers, and teens. Technology may be a useful tool for enhancing service delivery and promoting engagement among youth receiving trauma-focused mental health treatment.

Community-Based Learning Collaboratives and Participant Reports of Interprofessional Collaboration, Barriers to, and Utilization of Child Trauma Services.

Given the high prevalence and severe consequences of child trauma, effective implementation strategies are needed to increase the availability and utilization of evidence-based child trauma services. One promising strategy, the Community-Based Learning Collaborative (CBLC), augments traditional Learning Collaborative activities with a novel set of community-focused strategies. This prospective, observational study examined pre-to post-changes in CBLC participant reports of interprofessional collaboration (IPC), barriers to, and utilization of evidence-based child trauma treatment in their communities. Participants of five CBLCs from a statewide dissemination initiative, comprising 572 child abuse professionals (296 clinicians, 168 brokers, and 108 senior leaders), were surveyed pre-and post-CBLC participation. Results suggested that CBLCs significantly decreased barriers to child trauma treatment and significantly increased IPC and perceived utilization of evidence-based child trauma treatment. Further, changes in barriers partially mediated this relationship. Finally, small to medium differences in participants' reports were detected, such that senior leaders perceived significantly greater IPC than clinicians and brokers did, while brokers perceived significantly greater barriers to child trauma treatment than clinicians and senior leaders did. Collectively, these preliminary findings suggest the CBLC implementation model-which augments traditional Learning Collaborative models with a focus on fostering IPC-can reduce barriers and increase the utilization of evidence-based mental health treatment services.

Measurement Invariance of Adverse Childhood Experiences Across Teacher Age and Race.

Adverse Childhood Experiences (ACEs) confer considerable risk for negative outcomes across the lifespan, but there is limited research examining whether the measurement of ACEs can be interpreted the same way across diverse groups of individuals. In particular, the measurement of ACEs among early child education teachers has received little attention. Given that millions of children receive care from early child education teachers, and evidence that ACEs can severely disrupt teacher's abilities to support young children, it is critical to accurately assess for and respond to teacher ACEs. The present study examined the factor structure and measurement invariance of the 11-item Behavioral Risk Factor Surveillance Survey (BRFSS) version of the ACEs measure across a diverse group of teachers. Data were collected from 605 teachers in a southeastern state between 2018 and 2021. Teachers ranged in age from 18 to 81 years (35% young; 56% middle; and 9% older adults) and were diverse across race (46% White; 53% Black). Teachers completed the BRFSS version of the ACEs measure and a demographics questionnaire. Factor analyses replicated the theorized three-factor solution, with household dysfunction, emotional/psychological abuse, and sexual abuse emerging as distinct factors. Multigroup confirmatory factor analyses demonstrated measurement invariance across teacher age and race. Comparisons of scores indicated ACEs levels varied across teacher age and race. Overall, findings suggest the BRFSS version of the ACEs measure can be used to assess adverse childhood experiences across diverse groups of early child education teachers.

A qualitative analysis of black mother preparation for bias messages following incidents of racism-related violence.

Preparation for bias messages (PFB), represent a specific form of racial socialization, used to inform youth about racism and how to cope with racism-related adversity. Although research commonly examines how frequently PFB are delivered to children, few studies have qualitatively explored the heterogeneity in the content of such messages, making it difficult to ascertain how caregivers prepare and coach their children to negotiate incidents of racism-related violence. To address this gap in the literature, the present study qualitatively examined the content of PFB given to Black children from their mothers following high-profile incidents of anti-Black violence. Semistructured interviews were conducted with 12 mothers (Mage = 41.91) of Black children to explore how parental concerns regarding their children's safety inform the content of their PFB. Using thematic analysis, two primary themes emerged. The first theme related to psychosocial factors among caregivers that precipitated PFB (i.e., awareness of anti-Black violence, worry about the child being a victim). The second theme pertained to the different types of PFB that caregivers provided to their children (i.e., awareness of racial biases, strategies to navigate discriminatory encounters). Overall findings support and extend extant racial socialization research and have important implications for how Black youth come to understand the significance of race and racism in the aftermath of racism-related violence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Listening to Black Pregnant and Postpartum People: Using Technology to Enhance Equity in Screening and Treatment of Perinatal Mental Health and Substance Use Disorders.

Perinatal mood and anxiety disorders (PMADs), perinatal substance use disorders (PSUDs), and intimate partner violence (IPV) are leading causes of pregnancy-related deaths in the United States. Screening and referral for PMADs, PSUDs and IPV is recommended, however, racial disparities are prominent: Black pregnant and postpartum people (PPP) are less likely to be screened and attend treatment compared to White PPP. We conducted qualitative interviews to better understand the experience of Black PPP who used a text/phone-based screening and referral program for PMADs/PSUDs and IPV-Listening to Women and Pregnant and Postpartum People (LTWP). We previously demonstrated that LTWP led to a significant reduction in racial disparities compared to in-person screening and referral, and through the current study, sought to identify facilitators of PMAD/PSUD symptom endorsement and treatment attendance. Semi-structured interviews were conducted with 68 Black PPP who were or had been pregnant within the last 24 months, and who either had or did not have a PMAD or PSUD. Participants were enrolled in LTWP and provided feedback on their experience. Using a grounded theory approach, four themes emerged: usability, comfort, necessity, and recommendations. Ease of use, brevity, convenience, and comfort in discussing mental health and substance use via text were highlighted. Need for a program like LTWP in Black communities was discussed, given the reduction in perceived judgement and access to trusted information and resources for PMADs/PSUDs, which may lessen stigma. These qualitative findings illuminate how technology-based adaptations to behavioral health screening and referral can reduce perceived negative judgment and facilitate identification and referral to treatment, thereby more adequately meeting needs of Black PPP.

Posttraumatic Stress Disorder Among Adults in Communities With Mass Violence Incidents.

Importance: Mass violence incidents (MVIs) are prevalent in the US and can have profound and long-lasting psychological consequences on direct survivors, but their outcomes among the broader communities where the MVI occurred are unknown. Objective: To investigate the prevalence of and factors associated with past-year and current posttraumatic stress disorder (PTSD) among adults in communities that experienced an MVI. Design, Setting, and Participants: This cross-sectional survey was completed between February and September 2020 with a household probability sample of adults from 6 communities that had experienced an MVI between 2015 and 2019: Dayton, Ohio; El Paso, Texas; Parkland, Florida; Pittsburgh, Pennsylvania; San Bernadino, California; and Virginia Beach, Virginia. Address-based sampling was used to identify randomly selected households, mail invitations, and select 1 adult per household to complete a self-administered paper or online survey. Data analysis was performed from September to November 2023. Main Outcomes and Measures: The primary outcome was presumptive diagnostic-level past-year PTSD and current (past month) PTSD determined using American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) PTSD criteria. Results: A total of 6867 adults aged 18 years or older accessed the website with a description of the study and consent materials. Of these, 5991 (87.2%) agreed to participate and completed the survey, 343 (6.3%) partially completed the survey, and 443 (6.5%) did not meet eligibility criteria or refused to participate. Most of the 5991 respondents were female (3825 individuals [53.5%]) and had a mean (SD) age of 45.56 (17.58) years. A total of 1261 of 5931 individuals (21.0%) reported high exposure to the MVI (either they or a close friend and/or family member was on site during the shooting). Nearly one-quarter (23.7%; 1417 of 5977 participants reporting PTSD) met presumptive DSM-5 diagnostic criteria for past-year PTSD, with 8.9% (530 participants) meeting the criteria for current PTSD. Regression analyses found that being female (odds ratio, 2.32; 95% CI, 2.01-2.68) and having a history of both physical or sexual assault and other potentially traumatic events (odds ratio, 9.68; 95% CI, 7.48-12.52) were associated with the greatest risk of past-year PTSD. Conclusions and Relevance: In this survey study of 5991 participants, presumptive PTSD was quite prevalent long after the MVI among adults in communities that have experienced an MVI, suggesting that MVIs have persistent and pervasive public health impacts on communities, particularly among those with prior exposure to physical or sexual assault and other potentially traumatic events. Focusing exclusively on direct exposure to MVIs is not sufficient. Incorporating these findings into screening should improve efforts to identify the individuals most in need of prevention or mental health service after MVIs.

Measuring Grief in the Context of Traumatic Loss: A Systematic Review of Assessment Instruments.

Following traumatic loss, defined as the death of a loved one due to unexpected or violent circumstances, adults may experience a myriad of grief-related problems. Given the addition of Prolonged Grief Disorders into the Diagnostic and Statistical Manual for Mental Disorders Fifth Edition, Text-Revision and influx of unexpected deaths due to the global Coronavirus pandemic, there is heightened interest in the measurement of grief-related processes. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify measures of grief used in studies of adults who experienced traumatic loss. Searches yielded 164 studies that used 31 unique measures of grief-related constructs. The most commonly used instrument was the Inventory of Complicated Grief-Revised. Half of the measures assessed constructs beyond diagnosable pathological grief responses. Given the wide variation and adaptations of measures reviewed, we recommend greater testing and uniformity of measurement across the field. Future research is needed to adapt and/or design measures to evaluate new criteria for Prolonged Grief Disorder.

Assessment Tools for Children who Experience Traumatic Loss: A Systematic Review.

Children who experience the traumatic (i.e., violent and/or unexpected) death of a loved one are at risk for a range of adverse developmental and mental health problems, including pathological processes of grief. Over the last decades, conceptualizations of maladaptive grief have varied, resulting in a range of assessment tools and no "gold standard" measure to assess symptoms of prolonged grief in children. The current paper is a systematic review of studies that measured grief in children who experienced traumatic loss in order to determine the measures currently used in the literature with children who experience traumatic loss. Searches were conducted according to the preferred reporting items for systematic reviews and meta-analyses in PUBMED, PsycINFO, and OVID and through hand searches of relevant reference lists. Two authors reviewed each study yielded by searches and conducted data extraction on included studies. Studies were included if they were peer-reviewed, included a measure of grief, and consisted of samples of children (age 18 and younger) whereby at least a portion experienced traumatic loss. Thirty-nine studies met inclusion criteria, from which 17 measures were identified. The most commonly used measure was the Inventory of Complicated Grief (n = 10 studies) followed by the Extended Grief Inventory (n = 6). Most studies used different measures and variations of the same measures to assess similar constructs. All but one measure relied on child self-report. More standardization of measurement across studies is needed, along with parent and/or teacher reported measures.

Using the 5C model to understand COVID-19 vaccine hesitancy across a National and South Carolina sample.

Vaccine hesitancy is a serious threat to global health; however, significant COVID-19 vaccine hesitancy exists throughout the United States. The 5C model, which postulates five person-level determinants for vaccine hesitancy - confidence, complacency, constraints, risk calculation, and collective responsibility - provides one theoretical way of understanding COVID-19 vaccine hesitancy. The present study examined the effects of these 5C drivers of vaccine behavior on early vaccine adoption and vaccine intentions above and beyond theoretically salient demographic characteristics and compared these associations across a National sample (n = 1634) and a statewide sample from South Carolina (n = 784) - a state with documented low levels of COVID-19 vaccination uptake. This study used quantitative and qualitative data collected in October 2020 to January 2021 from the MFour-Mobile Research Panel, a large, representative non-probability sample of adult smartphone users. Overall, the South Carolina sample reported lower COVID-19 vaccine intentions and higher levels of 5C barriers to vaccine uptake compared to the National sample. Findings further indicated that both demographic characteristics (race) and certain drivers of vaccine behavior (confidence and collective responsibility) are associated with vaccine trust and intentions across samples above and beyond other variables. Qualitative data indicated that COVID-19 vaccine hesitancy was driven by fears about the quick vaccine development, limited research, and potential side effects. Although there are some limitations to the cross-sectional survey data, the present study offers valuable insight into factors associated with early COVID-19 vaccine hesitancy across the United States.

Sexual Assault, Posttraumatic Stress, Alcohol Use, and Suicidality Among Diverse College Students.

Suicide is the second leading cause of death among college-aged populations. This study examined the association of demographics (sexual orientation, gender identity, age, and race), sexual assault, posttraumatic stress symptoms (PTSS), and alcohol use with suicidality, current urge to self-harm, and current suicidal intent among a diverse sample of college students (n = 2,160) from two universities. Over half of participants reported any suicidality (63.5%), 12% reported current urge to harm themselves, and 5% reported current suicidal intent. A linear regression indicated that participants who identified as a sexual minority, gender minority, consumed more drinks per week, and had more severe PTSS reported higher levels of suicidality. University also was associated with suicidality. A negative binomial regression demonstrated that participants who identified as a sexual minority and had more severe PTSS had more current urge to harm themselves. Further, a negative binomial regression demonstrated that first-generation college students, students with more severe sexual assault histories, and students with more severe PTSS had higher current suicidal intent. Findings suggest that risk factors may differ for college students' general suicidality, self-harm urges, and suicidal intent, suggesting that these may be separate constructs. More comprehensive models, incorporating multiple risk factors and multiple ways of assessing suicidality, are needed to better understand the range of college student suicidal behavior and risks.

Development and feasibility testing of an integrated PTSD and adherence intervention cognitive processing therapy-life steps (CPT-L) to improve HIV outcomes: Trial protocol.

Despite high rates of Post-Traumatic Stress Disorder (PTSD) in persons living with HIV (PLWH) and poor HIV-related health outcomes associated with PTSD, an effective evidence-based treatment for PTSD symptoms in PLWH does not exist. Negative reinforcement conceptual models posit that avoidant behavior (hallmark symptom of PTSD) demonstrated by PLWH with co-occurring PTSD can contribute to poor antiretroviral therapy (ART) adherence. However, research evaluating the impact of evidence-based treatment for PTSD among HIV infected populations on HIV outcomes is scarce. The Cognitive Processing Therapy (CPT) protocol is an evidence-based PTSD treatment that may address internalized stigma with targeted modifications and improve ART adherence and subsequent viral suppression through reduction of avoidant coping. This study will be the first pilot open-label randomized control trial (RCT) to test feasibility of an integrated evidence-based PTSD treatment (CPT) with an adherence intervention (Lifesteps) delivered in a Ryan White clinic to improve PTSD symptoms, adherence to ART, and retention in HIV care. Primary aims are to (1) conduct theater testing of the CPT and Lifesteps research protocol and evaluate acceptability (n = 12) and (2) deliver a modified CPT protocol (CPT-Lifesteps, or CPT-L) in 60 PLWH/PTSD exploring impact of CPT-L on PTSD symptoms and HIV outcomes compared to a Lifesteps + Standard of Care condition. This innovative research extends PTSD treatment approaches as a paradigm to reduce barriers to ART adherence. Findings of this innovative study are significant because they support the Undetectable = Untransmittable (U[bond, double bond]U) campaign and can help prevent the transmission of HIV infection through increased viral suppression.

Incorporating evidence-based behavioral teacher training into Head Start mental health consultation: Description and initial outcomes of a large-scale program.

Development of a multicomponent mental health consultation program for a countywide Head Start program is described. The consultation program incorporates strategies from the evidence-based practice, Teacher-Child Interaction Training (TCIT). Through large group professional development trainings before the school year, comprehensive feedback reports based on observations, and in-class coaching via modeling and performance feedback on teachers' use of TCIT skills, the consultation program served 55 Head Start classrooms with 789 children. Outcome data are presented on teachers' improvement in TCIT skill use and the relative effectiveness of two coaching methods (i.e., modeling and performance feedback) used during consultation. Results from multilevel modeling analyses indicated that teachers improved in the use of multiple observed TCIT skills between the initial and midyear assessment (i.e., increased frequency of labeled praises, reflections, behavioral descriptions, and commands that were complied with; decreased frequency of commands that children did not have an opportunity to comply with). Additionally, teachers who received coaching in the form of performance feedback, in comparison to modeling, exhibited greater gains in the frequency of labeled praises and commands that resulted in compliance. Discussion focuses on implementation of evidence-based practice in large-scale preventative early interventions, study limitations, and directions for future research.

Longitudinal Relations among Adolescent Risk Behavior, Family Cohesion, Violence Exposure, and Mental Health in a National Sample.

Violence is a public health concern linked with mental health problems among adolescents, and risk behavior increases the likelihood of violence exposure. Family cohesion may attenuate the negative effects of risk behavior. The purpose of this study was to examine family cohesion as a moderator in the relation between risk behavior (substance use and delinquency) and violence exposure, and to explore longitudinal associations among cohesion, violence exposure, and subsequent mental health outcomes (PTSD and depression). Data were drawn from the National Survey of Adolescents-Replication, a nationally representative sample of 3604 adolescents, with data collected via structured phone interviews at three waves spanning a two-year period. Hypotheses were tested using longitudinal structural equation modeling. Findings revealed that high family cohesion attenuated the relation between risk behavior and subsequent violence exposure. Wave 2 violence exposure was associated with more Wave 3 mental health problems, but high family cohesion was related to fewer subsequent symptoms. Follow-up analyses revealed that family cohesion moderated the relation between risk behavior and experiencing, but not witnessing, violence. Several demographic associations were observed. Although risk behavior increases exposure to violence, and in turn, mental health problems, family cohesion may serve as a protective factor, attenuating the link between risk behavior and subsequent negative consequences. This effect emerged even when accounting for demographic and socioeconomic covariates. Interventions with adolescents should target family relationships as a protective factor to reduce risk of violence exposure and mental health problems, particularly for adolescents who are engaging in high-risk behaviors.

Implementing trauma-focused CBT for children of veterans in the VA: Providing comprehensive services to veterans and their families.

Military families experience unique stressful circumstances such as frequent moves, service-related physical and mental health difficulties, and separation from support. Although many families exhibit high resilience in response to these stressors, military children are at an increased risk for emotional and behavioral difficulties, exposure to intimate partner violence, and child maltreatment. These potential problems not only affect child functioning, but often also negatively impact family and veteran outcomes. Although the Department of Defense has enhanced efforts to address child and family trauma among military families, many veterans' families are still not receiving timely, evidence-based treatment. With many veterans receiving care through Veterans Affairs (VA) medical centers, incorporating family treatment into VA services is important for promoting optimal veteran outcomes. Trauma-focused cognitive-behavioral therapy (TF-CBT) has been used successfully for civilian and military children exposed to trauma including child maltreatment, intimate partner violence, and traumatic grief. This article reviews research regarding veterans' mental health, child and family functioning, and parenting, and highlights the value of implementing TF-CBT in the VA given its family and-resilience-focused structure, strong empirical support, and flexible delivery model. Strengths of delivering TF-CBT in the VA (e.g., provision of trauma services for families where veterans are already receiving care, family education about trauma), as well as implementation barriers (e.g., VA policy regarding veteran-focused treatment, reduced facility resources) are discussed. Finally, future research directions are proposed, including mixed-methods research with veterans' families to investigate the effectiveness and feasibility of TF-CBT dissemination within VA facilities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Statewide implementation of child trauma-focused practices using the community-based learning collaborative model.

A significant number of youth in the United States experience traumatic events that substantially increase the risk of physical and behavioral health problems across the life span. This public health concern warrants concerted efforts to promote trauma-informed, evidence-based practices that facilitate recovery. Although youth-focused trauma-specific treatments exist, determining effective ways to disseminate and implement these services-so that they are available, accessible, and sustainable-poses an ongoing challenge. This paper describes a comprehensive model for such implementation, the community-based learning collaborative (CBLC), developed as part of Project BEST, a four-phase statewide initiative to promote trauma-focused practices. The CBLC augments the learning collaborative model by including clinical and nonclinical (i.e., broker) professionals from multiple service organizations within a targeted community. CBLCs aim to build capacity for sustained implementation of trauma-focused practices by promoting interprofessional collaboration among those involved in the coordination and provision of these services. This paper describes the iterative development of the CBLC by examining participant completion data across the three completed phases of Project BEST (N = 13 CBLCs; 1,190 participants). Additionally, data from Project BEST's third phase (N = 6 CBLCs; 639 participants) were used to evaluate changes in the frequency of specific practices, pre- to post-CBLC, and post-CBLC perceived utility of CBLC components. High participant completion rates, significant increases in reported trauma-focused practices, and positive ratings of the CBLC's utility provisionally support the feasibility and efficacy of the model's final iteration. Implications for implementation and CBLC improvements are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).