Providing Clinical Psychology Training and Trauma-Focused Treatment via Telehealth During COVID-19.

To slow the spread of COVID-19 many mental health providers transitioned to telehealth delivery of trauma-focused treatment for maltreated children. However, these providers faced myriad challenges, including equitable access to equipment and technical demands of telehealth software. Training clinics overseeing pre-doctoral clinical psychology interns experienced the added challenge of providing quality supervision and training via telehealth. This study involves a retrospective application of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to describe the innovative adaptation to a telehealth service delivery model in a training clinic providing evidence-based trauma-focused treatment to children and their families. Mixed methods data from clinic records and intern evaluations indicate that compared to pre-COVID (February 2019 - February 2020), during early COVID (April 2020 - April 2021) more patients accessed clinic services, interns reported fewer hours of individual supervision, and interns reported greater satisfaction with their training experiences. Implications for ongoing provision of telehealth services are discussed.

Prevalence and Risk Factors of Depression and Posttraumatic Stress Disorder After a Mass Shooting.

This cross-sectional study examines the self-reported mental health outcomes of adults 4 years after witnessing and surviving the shooting at the Route 91 Harvest Music Festival in Las Vegas, Nevada.

Longitudinal predictors of children's self-blame appraisals among military families reported for family violence.

BACKGROUND: Although children's self-blame appraisals are recognized as important sequelae of child victimization that contribute to subsequent adjustment problems, little is known about the factors that predict their development and longitudinal course. OBJECTIVE: The current study examines the stability and longitudinal predictors of children's self-blame appraisals among a sample of children reported for family violence. PARTICIPANTS AND SETTING: Children (N = 195; 63 % female) aged 7 to 17 years (Mage = 12.17) were recruited as part of a longitudinal assessment of families referred to the United States Navy's Family Advocacy Program due to allegations of child physical abuse, sexual abuse, or intimate partner violence. METHODS: Children completed assessments on self-blame at 3 time points (baseline, 9-12 months, and 18-24 months) and baseline measures of their victimization experience, caregiver-child conflict, and depression. RESULTS: In univariate analyses, victimization that involved injury (r = 0.29, p < .001), the number of perpetrators (r = 0.23, p = .001), the number of victimization types (r = 0.32, p < .001), caregiver-child conflict (r = 0.36, p < .001), and depression (r = 0.39, p < .001) were each positively associated with baseline self-blame. When examined in a single longitudinal multilevel model, results indicated only caregiver-child conflict (b = 0.08, p = .007) and baseline depression (b = 0.06, p = .013) predicted increases in self-blame. CONCLUSION: Findings suggest clinicians and researchers may consider assessment of victimization characteristics, caregiver-child relationships, and depression symptoms to identify children most at risk for developing self-blame appraisals.

Associations of caregiver-adolescent conflict and caregiver emotional support with adolescent trauma symptoms and adjustment after sexual abuse.

BACKGROUND: Emotional support from a caregiver is believed to be important for reducing the likelihood of adolescent trauma symptoms and adjustment problems after sexual abuse. Conflict with a caregiver, another relational dynamic, is very common during adolescence, but little is known about how it might operate in tandem with emotional support to influence adolescent trauma symptoms and adjustment after sexual abuse. OBJECTIVE: To better understand how caregiver emotional support and caregiver-adolescent conflict jointly contribute to adolescent trauma symptoms and adjustment after sexual abuse. PARTICIPANTS AND SETTING: Participants were 477 adolescents (Mage = 13.59, SD = 1.77) and a non-offending caregiver presenting at a children's advocacy center. METHODS: Adolescents completed measures of caregiver-adolescent conflict, caregiver emotional support, and their own trauma symptoms and adjustment. Caregivers completed a measure of adolescent adjustment. RESULTS: Caregiver-adolescent conflict and caregiver emotional support each correlated in the expected direction with adolescent trauma symptoms and adjustment (conflict correlations ranged from 0.27 to 0.38, all p values ≤.001; support correlations ranged from -0.15 to -0.21, all p values ≤.01). Regression analyses, which simultaneously considered conflict and support, indicated that conflict related to adolescent trauma symptoms and each of the measures of adolescent adjustment, whereas caregiver emotional support contributed to caregiver reports of adolescent adjustment. Caregiver-adolescent conflict did not moderate any of the relations between caregiver emotional support and adolescent trauma symptoms or adjustment. CONCLUSIONS: In the aftermath of sexual abuse, caregiver-adolescent conflict contributes to adolescent trauma symptoms and adjustment.

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.

Longitudinal Predictors of Mother- and Child-Report of Maternal Support Following Child Sexual Abuse.

Maternal support is theorized as a critical predictor of children's recovery from sexual abuse. However, following disclosure, several factors may cause maternal support to fluctuate over time. This study examined the effects of hypothesized risk factors, mother's relationship to the perpetrator and maternal psychological distress, as well as protective factors, maternal belief of disclosure, lower levels of child blame, and mother-child relationship quality, as predictors of change in maternal support over a 9 month period. Mothers (Mage = 38.42, SD = 8.99) and their children (Mage = 11.57, SD = 2.69; 85% female), recruited from a child advocacy center following sexual abuse disclosure, completed measures of maternal support. Mothers reported on their relationship to the perpetrator, psychological distress, belief of disclosure, child blame, and mother-child relationship quality. On average, mother- and child-reports of maternal support were stable across time. Belief of disclosure and child blame predicted mother- and child-report of maternal support. Psychological distress and mother-child relationship quality predicted change in mother-report, but not child-report of maternal support. Researchers and clinicians should consider potential fluctuations in maternal support in assessment and intervention following child sexual abuse.

Adolescents Who Have Been Sexually Abused: Trauma Symptoms and Self-Blame while Waiting for Treatment.

OBJECTIVE: Adolescents who have been sexually abused commonly experience trauma symptoms, and many are referred for trauma-based treatment. However, they sometimes spend considerable time on waitlists before beginning treatment. This study examines the course of trauma symptoms among adolescents who have been sexually abused and are waiting for treatment, and the extent to which self-blame for the abuse predicts trauma symptoms at the beginning of treatment. METHOD: Participants were 127 adolescents (89.0% female, Mage = 13.61 years; 53.2% identified as Hispanic) at a Children's Advocacy Center in the southern United States. All had reported being sexually abused. Participants reported on their trauma symptoms and self-blame appraisals at a screening assessment (T1), and trauma symptoms were re-assessed at the beginning of treatment (T2). RESULTS: The mean level of trauma symptoms declined over time for the total sample. Regression analyses indicated that greater self-blame for the abuse at T1 was associated with higher levels of trauma symptoms at T2, even when controlling for T1 trauma symptoms and other correlates of T2 trauma symptoms. Higher levels of trauma symptoms at T1 and adolescent sex (female) were also associated with higher levels of trauma symptoms at T2. CONCLUSIONS: Findings suggest that assessing for self-blame for sexual abuse may be important in triage and treatment planning for youth with trauma symptoms after experiencing sexual abuse.

Measurement invariance of caregiver support following sexual abuse across age, relationship, and English-Spanish language.

BACKGROUND: The Maternal Self-report Support Questionnaire (MSSQ) is among the most rigorously evaluated measures of caregiver support following child sexual abuse, but there is a paucity of data on the factor structure and variance of the MSSQ across diverse groups of caregivers and their children. OBJECTIVE: The present study examined the factor structure and measurement invariance of the MSSQ across 386 non-offending caregivers following a disclosure of child sexual abuse. PARTICIPANTS AND SETTING: Data were collected from non-offending caregivers at two Child Advocacy Centers (n = 277; n = 109) in the United States. METHODS: Caregivers completed the MSSQ and assessments of child age, caregiver-child relationship, and caregiver preferred language. RESULTS: Confirmatory factor analyses replicated the original two-factor structure, with the emotional support and blame/doubt subscales emerging as distinct factors. Multigroup confirmatory factor analyses showed measurement invariance across child age and caregiver-child relationship (mother vs. another caregiver). Evidence of partial invariance was found for caregiver preferred language. Comparisons of scores indicated caregiver support varied by child age and caregiver preferred language. CONCLUSIONS: Overall, findings suggest the MSSQ can be used to measure caregiver support across caregivers with children of different ages and both mothers and non-mothers, but caution should be practiced in interpreting mean-level differences between English- and Spanish-speaking caregivers.

Self-Blame in Adolescents Who Have Been Sexually Abused: Factor Structure and Differential Correlates of Abuse-Specific and Global Measures.

Self-blame appraisals are frequently studied among adolescents following sexual abuse. However, the conceptualization and operationalization of self-blame varies across studies, with some examining self-blame specific to the abuse and others examining global self-blame. The present study examined the factor structure and theorized correlates of measures of self-blame appraisals among a sample of adolescents who had been sexually abused (N = 493, 91% female). Results of confirmatory factor analyses indicated that a two-factor model, in which abuse-specific and global self-blame appraisals load onto separate factors, produced a superior model fit compared with a single-factor model, though the two factors were highly correlated. Abuse-specific and global self-blame appraisals are differentially associated with theorized correlates, such as experiencing coercion during the abuse. Taken together, the findings suggest that adolescents' abuse-specific and global self-blame appraisals following sexual abuse are measuring distinct constructs.

Intimate Partner Violence, Police Involvement, and Women's Trauma Symptoms.

This study examined whether police involvement in intimate partner violence (IPV) incidents is associated with women's trauma symptoms. Participants were 95 women recruited from domestic violence shelters. Women reported on their trauma symptoms, the frequency of IPV victimization, the use of a weapon during IPV, and police involvement over the year following shelter departure. Police involvement in IPV was associated with higher levels of reexperiencing trauma symptoms 1 year after shelter departure, even after controlling for baseline trauma symptoms, the frequency of IPV, and the use of a weapon during IPV. Women's race and ethnicity did not moderate the results. These findings suggest police involvement in IPV incidents may be associated with higher levels of trauma symptoms experienced by women. Further investigation into law enforcement practices and policies to help reduce women's distress is needed.

Families seeking services for sexual abuse: Intimate partner violence, mothers' psychological distress, and mother-adolescent conflict.

Child sexual abuse (CSA) and intimate partner violence (IPV) are both global problems with negative health implications. This study examines whether mothers' lifetime experiences of IPV relate to their own psychological distress and to mother-adolescent conflict in families in which an adolescent has disclosed sexual abuse. The recency of IPV was examined as a potential moderator of these relations. Participants were 356 adolescents and their nonoffending mothers. Families were seeking services from a children's advocacy center in the southern United States. Mothers reported their IPV victimization (both lifetime and past month) and symptoms of psychological distress; mothers and adolescents both reported on mother-adolescent conflict. In bivariate analyses, mothers' lifetime experiences of IPV were positively related to mothers' psychological distress, and to mother and adolescent reports of mother-adolescent conflict. These same relations emerged in regression analyses that controlled for characteristics of the sexual abuse (time between the disclosure of CSA and the assessment, severity, relationship to the alleged perpetrator, duration), and adolescent age and sex. Recency of IPV did not moderate these relations. In exploratory analyses, mothers' lifetime experiences of IPV were more strongly associated with mother-son conflict than with mother-daughter conflict. In addition, mothers' psychological distress partially mediated the relation between their lifetime experiences of IPV and their reports of mother-adolescent conflict. The findings point to the potential utility of conducting IPV screenings with caregivers in families seeking services for an adolescent after a sexual abuse disclosure. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Caregiver and divine support: Associations with resilience among adolescents following disclosure of sexual abuse.

BACKGROUND: Social support is believed to be important for fostering adolescent resilience following sexual abuse. Caregiver support is often examined as a source of support for adolescents, but divine support (support from God or a higher power) has received scant research attention. OBJECTIVE: This study examines relations of caregiver support and divine support with resilience following adolescent sexual abuse. PARTICIPANTS AND SETTING: Participants were 548 adolescents aged 11-17 (Mage = 13.78; 91% female) and their non-offending caregivers (Mage = 39.68; 79% mothers). Families were recruited from a children's advocacy center located in the southern United States following a disclosure of sexual abuse. METHODS: Adolescents completed measures of caregiver and divine support and their social and academic functioning; caregivers and adolescents reported on adolescent psychological functioning. Resilience was operationalized as the absence of clinical levels of psychological symptoms together with the presence of adaptive levels of social and academic functioning. RESULTS: Both caregiver support (r = .19, p < .001) and divine support (r = .14, p = .001) were positively associated with resilience. Considered together in regression analyses, caregiver support (OR = 1.02, p = .001) and divine support (OR = 1.06, p = .04) were both associated with resilience. CONCLUSION: Clinicians and researchers should consider the potential contribution of caregiver and divine support to adolescent resilience following sexual abuse.

Police Involvement in Intimate Partner Violence and Children's Anxiety Symptoms.

This study examined whether police involvement in intimate partner violence (IPV) is associated with children's anxiety symptoms and threat appraisals. Participants were 117 mothers and their children (7-10 years) recruited from domestic violence shelters and followed for 6 months. Mothers reported on IPV and police involvement in the past 6 months; children reported their own anxiety symptoms and threat appraisals. Police involvement in IPV incidents at Time 1 was positively related to children's anxiety symptoms at both the Time 1 and Time 2 assessments, even after controlling for the severity of the IPV. Police involvement was not associated with children's threat appraisals. Police involvement in IPV may inadvertently contribute to an increase in children's anxiety symptoms. Efforts to mitigate adverse outcomes should be investigated.

Self-blame for interparental conflict among female adolescents who have been sexually abused.

This study evaluated whether self-blame appraisals for interparental conflict relate to conduct problems among female adolescents who have been sexually abused. Participants included female adolescents who had experienced sexual abuse and a current, primary nonabusing caregiver. Families presented for services at a children's advocacy center. Female adolescents (N = 263, Age 11-17 years, M = 13.68, SD = 1.74) reported on conduct problems, self-blame appraisals for interparental conflict, self-blame appraisals for their sexual abuse, perceptions of the frequency and severity of interparental conflict, and whether the sexual abuse involved coercion. Caregivers reported on adolescent conduct problems and their contact with a romantic partner. Adolescent relationship to the alleged abuser and the severity and duration of the sexual abuse were coded from forensic interviews and case records. Adolescent self-blame appraisals for interparental conflict were positively associated with adolescent and caregiver reports of adolescent conduct problems. These relations emerged even after controlling for other theoretically important variables, such as self-blame appraisals for sexual abuse. Adolescent appraisals for interparental conflict may be an important target for assessment and intervention for female adolescents who have been sexually abused. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Mediating Role of Trauma Symptoms in the Association between Past and Future Teen Dating Violence Victimization.

We examined whether the frequency of recent physical and sexual teen dating violence (TDV) victimization is positively associated with trauma symptom clusters (re-experiencing, avoidance, and hyperarousal), and whether these symptom clusters, in turn, are positively associated with the frequency of later TDV victimization. Participants were recruited primarily from truancy courts, and the sample consisted of 108 (47% female) 14-to-17-year-olds. Participants completed three assessments, spaced three months apart. Results indicated that the frequency of recent TDV victimization related positively to all three trauma symptom clusters. Re-experiencing symptoms mediated the relation between recent TDV victimization and TDV victimization six months later, even after controlling for exposure to community and interparental violence and demographic variables. The findings suggest that the trauma symptom clusters may differentially contribute to risk of future TDV victimization. Further research examining the cognitive and emotional processes involved in re-experiencing trauma symptoms will likely enhance our understanding of risk factors for TDV re-victimization.

Perceived Loss of Social Contact and Trauma Symptoms among Adolescents Who Have Experienced Sexual Abuse.

Child sexual abuse (CSA) is a robust predictor of trauma symptoms. Past research has identified many correlates of trauma symptoms following disclosure of CSA. Theory suggests that loss of social contact may be another important contributor to adolescents' trauma symptoms following CSA. A clinical sample of 166 adolescents (95% female) between 11 and 19 years (M = 13.80, SD = 1.87) reported on perceived loss of social contact, the extent to which the CSA was coercive, appraisals of self-blame for the abuse, supportiveness of a primary non-abusing caregiver, and trauma symptoms. The adolescent's relationship to the abuser, abuse severity and duration were coded from forensic interviews. Results indicated that greater perceived loss of social contact was associated with higher levels of trauma symptoms, even after controlling for other correlates of trauma symptoms and demographic variables. These findings suggest that perceived loss of social contact may be an important variable to consider in assessing and intervening with adolescents who have been sexually abused.

Children Exposed to Intimate Partner Violence: Conduct Problems, Interventions, and Partner Contact With the Child.

Children's contact with their mother's violent partner is a potentially important variable for understanding conduct problems among children exposed to intimate partner violence (IPV). Within the context of a treatment study evaluating a parenting intervention (Project Support) for families exiting a domestic violence shelter, this study tested four hypotheses regarding children's postshelter contact with their mother's violent partner: (1) participation in Project Support decreases the frequency of children's contact with their mother's violent partner; (2) postshelter contact is positively associated with children's conduct problems and is associated more strongly for girls than boys; (3) frequency of contact mediates Project Support's effects on children's conduct problems; and (4) frequency of contact is positively associated with IPV and partner-child aggression, and these latter associations help explain effects of contact on children's conduct problems. Participants were 66 women (26 White) with a child (32 girls) between 4 and 9 years. Families were assessed every 4 months for 20 months after departure from a domestic violence shelter. Project Support reduced the extent of partner-child contact. In addition, within-subject changes in contact over time were associated with girls', but not boys', conduct problems, and it partially mediated effects of Project Support on girls' conduct problems. Higher average levels of contact over time were also positively associated with further incidents of IPV and partner-child aggression, and partner-child aggression helped explain effects of contact on children's conduct problems. Children's postshelter contact with the mother's violent partner relates positively to several negative family outcomes.

Teen Dating Violence Victimization, Trauma Symptoms, and Revictimization in Early Adulthood.

PURPOSE: This research examined whether experiencing physical teen dating violence (TDV) relates to trauma symptoms, which in turn, predict future physical dating violence victimization in early adulthood. METHODS: Adolescents (N = 843) recruited from high schools reported on their experiences of physical TDV victimization and trauma symptoms. The sample was followed over a 5-year period to assess for revictimization in early adulthood. RESULTS: Trauma symptoms functioned as a mediator between experiences of physical TDV victimization during adolescence and later revictimization in early adulthood, even in a conservative test of mediation that controlled for baseline trauma symptoms. Multigroup analyses testing for gender differences suggest that this mediation model is significant for females but not for males. CONCLUSIONS: The present findings suggest that the mental health consequences of experiencing physical TDV are an important factor contributing to future victimization in early adulthood. This holds potentially important implications for school-based efforts for reducing physical TDV. Specifically, school-based efforts to reduce victimization may be enhanced by supplementing existing efforts with empirically supported programs for addressing trauma symptoms.

Disclosing neuroimaging incidental findings: a qualitative thematic analysis of health literacy challenges.

BACKGROUND: Returning neuroimaging incidental findings (IF) may create a challenge to research participants' health literacy skills as they must interpret and make appropriate healthcare decisions based on complex radiology jargon. Disclosing IF can therefore present difficulties for participants, research institutions and the healthcare system. The purpose of this study was to identify the extent of the health literacy challenges encountered when returning neuroimaging IF. We report on findings from a retrospective survey and focus group sessions with major stakeholders involved in disclosing IF. METHODS: We surveyed participants who had received a radiology report from a research study and conducted focus groups with participants, parents of child participants, Institutional Review Board (IRB) members, investigators and physicians. Qualitative thematic analyses were conducted using standard group-coding procedures and descriptive summaries of health literacy scores and radiology report outcomes are examined. RESULTS: Although participants reported high health literacy skills (m = 87.3 on a scale of 1-100), 67 % did not seek medical care when recommended to do so; and many participants in the focus groups disclosed they could not understand the findings described in their report. Despite their lack of understanding, participants desire to have information about their radiology results, and the investigators feel ethically inclined to return findings. CONCLUSIONS: The language in clinically useful radiology reports can create a challenge for participants' health literacy skills and has the potential to negatively impact the healthcare system and investigators conducting imaging research. Radiology reports need accompanying resources that explain findings in lay language, which can help reduce the challenge caused by the need to communicate incidental findings.