Training Master of Social Work Students in Brief Intervention for Unhealthy Alcohol Use: Results of a Validated Adherence Assessment.

BACKGROUND: Many social workers receive limited training in working with clients engaged in unhealthy substance use. As a result, national organizations and agencies such as the Council on Social Work Education and individual social work programs are beginning to address this need by incorporating training into higher education social work programs. The purpose of this study was to examine Master of Social Work (MSW) students' adherence to a brief intervention protocol for unhealthy alcohol use. METHODS: A total of 91 MSW students consented to the assessment of their digital, audio-recorded class assignment by independent raters. RESULTS: Although 90% of MSW student participants were found to be overall adherent to the protocol, gaps in training quality were also identified. CONCLUSIONS: Lessons learned for addressing the gaps are discussed, along with future directions for teaching and learning in social work related to substance use.

Mental health among university employees during the COVID-19 pandemic: The role of previous life trauma and current posttraumatic stress symptoms.

OBJECTIVE: Previous studies indicated that the coronavirus disease 2019 (COVID-19) pandemic has harmed the mental health of diverse samples. Adopting a trauma lens with a sample of university faculty and staff, this study examined risk conferred by previous exposure to traumatic life events (TLE) on pandemic-related mental health harm (MHH) and stress and the mediating influence of posttraumatic stress disorder (PTSD) symptoms. METHOD: In Spring 2021, employees (N = 641) of a public university in the United States completed an online cross-sectional survey, including validated scales of TLE and PTSD and single-item measures of MHH and stress taken from published COVID-19 studies. A structural probit model was used to estimate: (a) direct effects of cumulative TLE on PTSD, MHH, and stress; and (b) indirect effects of cumulative TLE via PTSD adjusting for age. Gender was tested as a moderating influence. RESULTS: Nearly 36% of the sample reported positive PTSD screens along with high levels of MHH (22.5%) and stress (42.3%). Cumulative TLE was significantly and positively associated with MHH and stress. Both genders experienced a negative impact on mental health and stress either fully or partially through PTSD symptoms; however, the gender by trauma interaction term was not significant. As age decreased, PTSD and MHH increased. CONCLUSION: Results suggest that PTSD symptoms play a crucial role in the experience of MHH and stress during the pandemic for those who endured previous trauma. Implications for employer policies, public health messaging, and mental health services are explored. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Assessing Polyvictimization in a Family Justice Center: Lessons Learned From a Demonstration Project.

There is a growing interest in developing comprehensive assessments that measure intimate partner violence (IPV) alongside other adverse events that correlate with IPV and compound its effects. One promising line of research in this area has focused on the impact of exposure to multiple types of victimization, i.e., polyvictimization. The purpose of this study is to examine the experience of administration of a polyvictimization tool from staff and client perspectives in order to inform future tool developments and assessment procedures. Qualitative interviews and focus groups with clients and staff from a family justice center who had experience with the assessment tool were used to identify strengths and challenges of the assessment too and inform future tool development. Findings demonstrate that an assessment tool provides the space for clients to talk about trauma and facilitate empowerment, while providing the opportunity for psychoeducation and service referrals. Concerns about the assessment tool included adverse reactions without proper framing and language, as well as shifting the emphasis from screening for adversities toward strengths, coping skills, and resilience. Implications for future measurement development and establishing best practices in polyvictimization assessment are discussed, with an emphasis on the benefits of social service agencies utilizing assessment tools.

Increasing mental health treatment access and equity through trauma-responsive care.

Adverse childhood experiences and other potentially traumatic events have lasting implications for mental health. Evidence-based treatments are available to address trauma-related symptoms, but their impact is hindered because access is limited and unequal. In the U.S., adverse experiences and mental disorders disproportionately affect socioeconomically disadvantaged groups that face treatment access barriers-disparities that are compounded by passive systems of care that wait for clients to seek treatment. This article presents a conceptual argument, backed by empirical evidence, that population health can be improved by implementing trauma-responsive practices, and that greater mental health equity can be achieved if these strategies are used to engage underserved clients. A description is provided of the Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT), a promising protocol that can be used by nonclinical providers to detect trauma-related mental health concerns in adults and help them access therapeutic services. The T-SBIRT protocol has been successfully implemented in diverse settings, and it is currently being piloted in a universal postpartum home visiting program called Family Connects. Prior results from three trials of Family Connects are summarized, including evidence of program impact on maternal mental health. New results are also presented indicating that T-SBIRT is feasible to implement within Family Connects, as denoted by indicators of suitability, tolerability, provider adherence, and referral acceptance. Closing recommendations are offered for reducing mental health disparities by testing and disseminating T-SBIRT through Family Connects and other large-scale programs and systems of care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A mutual process of healing self and healing the community: A qualitative study of coping with and healing from stress, adversity, and trauma among diverse residents of a midwestern city.

Residents of urban American neighborhoods facing economic hardship often experience individual and collective adversities at high levels. This study explores how racially diverse adults experience stress, adversity, and trauma, and how they cope and heal in the context of their environment. Following a critical realist grounded theory methodology, four focus groups were conducted with African American, White and Latinx participants (N = 21) within an employment service program. Participants identified key stressors ranging from financial and job challenges, violence, and trauma. To cope with and heal from adversity, they practiced positivity, named trauma and its effects, sought social connection, envisioned community-based resources, and addressed structural and systemic barriers. The data generated a theory of "a mutual process of healing self and healing the community" through intrapersonal, interpersonal, and structural change. The results of this study indicate a need for peer-led, community-engaged initiatives and holistic, trauma-informed, healing-centered practices.

Influence of race/ethnicity and income on the link between adverse childhood experiences and child flourishing.

BACKGROUND: The impact of early adversity increases the risk of poor outcomes across the life course. Identifying factors that protect against or contribute to deleterious life outcomes represents an important step in resilience promotion among children exposed to adversity. Informed by resilience science, we hypothesized that family resilience mediates the relationship between adverse childhood experiences (ACEs) and child flourishing, and these pathways vary by race/ethnicity and income. METHODS: We conducted a secondary data analysis using the 2016-17 National Survey of Children's Health data reported by parents/guardians for 44,686 children age 6-17 years. A moderated-mediation model estimated direct, indirect, and total effects using a probit link function and stacked group approach with weighted least square parameter estimates. RESULTS: The main variables were related in expected directions. Family resilience partially mediated the ACEs-flourishing association. Although White and socioeconomically advantaged families were more likely to maintain family resilience, their children functioned more poorly at high-risk levels relative to Black and Hispanic children and across income groups. CONCLUSION: Children suffer from cumulative adversity across race/ethnicity and income. Partial mediation of family resilience indicates that additional protective factors are needed to develop comprehensive strategies, while racial/ethnic differences underscore the importance of prevention and intervention programs that are culturally sensitive. IMPACT: The key message of the article reinforces the notion that children suffer from cumulative adversity across race/ethnicity and income, and prevention of ACEs should be the number one charge of public policy, programs, and healthcare. This is the first study to examine family resilience in the National Survey Children's Health (NSCH) data set as mediating ACEs-flourishing by race/ethnicity and family poverty level. Examining an ACEs dose-response effect using population-based data within the context of risk and protective factors can inform a public health response resulting in a greater impact on prevention efforts.

Adverse childhood experiences and psychological well-being in a rural sample of Chinese young adults.

BACKGROUND: International interest in adverse childhood experiences (ACE) is on the rise. In China, recent research has explored the effects of ACEs on health-related outcomes, but little is known about how ACEs impact the psychological functioning of rural Chinese youth as they make transition to adulthood. OBJECTIVE: This study is aimed to assess the prevalence and psychological consequences of ACEs among a group of rural Chinese young adults. PARTICIPANTS AND SETTINGS: 1019 rural high school graduates from three different provinces of China participated in this study. METHODS: A web-based survey was used to assess ten conventional ACEs and seven other novel ACEs using the Childhood Experiences Survey. Using validated brief measures, six indicators of psychological functioning were assessed: anxiety, depression, perceived stress, posttraumatic stress, loneliness, and suicidality. Descriptive and correlational analyses of all ACEs were performed, and multivariate regressions were conducted to test associations between ACEs and study outcomes. RESULTS: Three-fourths of Chinese youth endorsed at least one of ten conventional ACEs. The most prevalent ACEs were physical abuse (52.3 %) and domestic violence (43.2 %). Among seven new adversities, prolonged parental absence (37.4 %) and parental gambling problems (19.7 %) were most prevalent. Higher conventional ACEs scores were significantly associated with poorer psychological functioning, and each type of new adversity was associated with one or more psychological problems. CONCLUSION: ACEs were prevalent among rural Chinese young adults and had deleterious effects on their psychological well-being. Further work is needed to address ACEs by developing culturally appropriate assessment practices, interventions, and policy responses.

Translating and Implementing Evidence-Based Mental Health Services in Child Welfare.

Children in the child welfare system with mental health difficulties seldom receive evidence-based treatment (EBT) despite the abundance of validated interventions that exist. This manuscript describes two projects aimed at increasing access to EBTs. The first is a completed field trial of an adapted parent-child interaction therapy intervention with foster-parent child dyads. New findings are presented from variable- and person-centered analyses of impact on diverse symptom profiles. The second is an ongoing statewide initiative that is increasing access to multiple EBTs while navigating implementation barriers. Lessons learned for bridging gaps between children's mental health research, services, and policy are discussed.

Evaluation of a Motivation-Based Intervention to Reduce Health Risk Behaviors among Black Primary Care Patients with Adverse Childhood Experiences.

BACKGROUND: Considerable evidence suggests that greater attention should be paid to the impact of trauma among low-income, racial/ethnic minority patients living in urban communities. The goal of this article is to evaluate a 2-session, motivational intervention designed to motivate a change in health risk behaviors among low-income, self-identified Black/African American patients with adverse childhood experiences (ACEs). METHODS: Qualitative self-reported data described helpful aspects of the intervention and those that could be improved. Eligible participants with 1 or more ACEs being seen in a community-based clinic were interviewed by a mental health clinician researcher for 2 in-person sessions scheduled 1 month apart. Content analysis was performed using a general inductive approach to identify core themes. RESULTS: In total, 36 of 40 participants completed both sessions, with the majority reporting a high rate of satisfaction. Participants emphasized the importance of talking with a trained professional who could listen without judgment, understand patient challenges, clarify patient goals, and facilitate behavior change plans. Suggestions for improvement included modifying structure and content, enhancing clinic environment, improving linkages to behavioral health, and increasing communication and collaboration with clinicians. CONCLUSION: Participant evaluation data gathered for this study suggest that through the practice of asking, listening, and accepting, clinicians can help patients who have been exposed to childhood adversity better understand themselves and promote healthy coping behaviors. This study provides preliminary data on the needs of underserved patients that can be utilized to develop and deliver health promotion interventions using a trauma-informed approach in community-based clinics.

Mediational pathways of meditation and exercise on mental health and perceived stress: A randomized controlled trial.

This study investigated the effects of mindfulness and exercise training on indicators of mental health and stress by examining shared mediators of program effects. Community-recruited adults (N = 413) were randomized into one of three conditions: (a) mindfulness-based stress reduction, (b) moderate intensity exercise, or (c) wait-list control. Composite indicator structural equation models estimated direct, indirect, and total effects. Results showed that mindfulness-based self-efficacy fulfilled a prominent role in mediating meditation and exercise program effects. Findings suggest that mindfulness and exercise training share similar mechanisms that can improve global mental health, including adaptive responses to stress.

The transmission of violence and trauma across development and environmental contexts: Intimate partner violence from the perspective of men with histories of perpetration.

BACKGROUND: Research has established a relation between ecological contexts and intimate partner violence (IPV), but little is known about how environmental factors affect childhood development over time and culminate in IPV perpetration from the perspective of men who perpetrated IPV. METHODS: Using grounded theory, this study employed focus groups with 32 predominately low-income, African American men in batterer intervention programs to explore factors and processes through which families, neighborhoods, and policy influence men's development, contributing to their use of IPV. Using an inductive approach, the researchers cycled between data collection and analysis resulting in a parsimonious conceptual model validated by participants. RESULTS: Three core categories emerged from focused and axial coding: adverse childhood experiences (ACEs) and trauma, structural forces, and systemic forces. Theoretical coding illuminated how these core categories relate to each other, producing a collective narrative illustrating how environmental contexts contributed to men's development. Study participants described childhood exposure to adversity and trauma within the home that diminished essential foundations of trust and safety. Positive (e.g., Old Heads, matriarchs) and negative (e.g., gangs, community violence) structural neighborhood forces influenced the social learning of violence and exposed participants to re-traumatization outside the home during their adolescence. Finally, key macro forces such as mass incarceration exacerbated violence and trauma exposure through the proliferation of high-risk neighborhoods, predisposing men toward IPV as young adults. CONCLUSIONS: Findings reinforce the notion that environmental stress not buffered by protective adults profoundly affects development and behavior. From the perspective of male perpetrators, our results help identify those stressors and how they might contribute to male-to-female IPV.

Applied and Translational Research on Trauma-Responsive Programs and Policy: Introduction to a Special Issue of the American Journal of Community Psychology.

The special issue highlights work across systems that include child welfare, education, juvenile justice and health, as well as agencies serving adults who are at-risk for high levels of childhood and adult trauma exposure. While articles appearing in the special issue are not divided equally across these systems, they cover important and overlapping concepts within each. Some articles span more than a single system or domain of research, whereas others fit primarily within single area or domain. Articles provide new insights from research on practices, programs, and policies that help to transform systems so they are increasingly more responsive to the needs of vulnerable populations.

Implementing Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT) within Employment Services: A Feasibility Trial.

Research suggests that low-income adults accessing employment services have experienced high levels of trauma exposure and associated consequences. Moreover, the health-related effects of trauma undermine employment and employability. A trauma-informed protocol-trauma screening, brief intervention, and referral to treatment or T-SBIRT-was therefore implemented within employment service programs serving low-income urban residents. To assess the feasibility of integrating T-SBIRT within employment services, five domains were explored as follows: suitability, acceptability, client adherence, provider adherence or fidelity, and intended outcomes. With a sample of low-income adults (N = 83), the study revealed that T-SBIRT is suitable for employment service participants given high rates of trauma exposure (90.4% experienced two or more lifetime traumas), along with high rates of positive screening results for post-traumatic stress disorder (48.8%), major depression (35.4%), and generalized anxiety (47.6%). Study participants appeared to find T-SBIRT acceptable as evidenced by an 83% acceptance rate. All participants accepting T-SBIRT services completed them, revealing strong client adherence. Provider adherence or model fidelity was high, that is, 98.5%. Finally, the majority of participants accepted a referral to a mental health care (i.e., 56.6%), and over three-quarters accepted a referral to any outside service including primary or mental health care. Implications of findings are discussed.

Addressing adverse childhood experiences and health risk behaviors among low-income, Black primary care patients: Testing feasibility of a motivation-based intervention.

OBJECTIVE: This pilot study tests the feasibility of implementing a two-session intervention that addresses adverse childhood experiences (ACEs), post-traumatic stress symptoms, and health risk behaviors (HRBs) among Black primary care patients. African Americans are disproportionately exposed to stressful and traumatic events and are at greater risk for PTSD than the general population. METHOD: A prospective cohort, experimental (pre-post) design with 2 post-intervention assessments were used to evaluate the feasibility of a motivation-based intervention for Black primary care patients with one or more ACEs. Indicators of feasibility implementation outcomes were assessed by participant adherence to treatment; suitability, satisfaction, and acceptability of the intervention; in addition to clinical outcomes of stress, HRBs, and behavioral health referral acceptance. RESULTS: Out of 40 intervention participants, 36 completed the intervention. Of the patients with one or more ACEs who participated in the intervention, 65% reported 4 or more ACEs and 58% had positive PTSD screens, and nearly two-thirds of those had at least one HRB. Satisfaction with the program was high, with 94% of participants endorsing "moderately" or "extremely" satisfied. The sample showed significant post-intervention improvements in stress, alcohol use, risky sex, and nutrition habits. Although stress reduction continued through 2-month follow-up, unhealthy behaviors rebounded. Almost one-third of participants were connected to behavioral health services. CONCLUSIONS: Brief motivational treatment for ACEs is feasible in underserved primary care patients and could help individuals develop healthier ways of coping with stress and improve health.

Medical Students' Perspectives on Trauma-Informed Care Training.

INTRODUCTION: Adults exposed to traumatic events during childhood commonly seek medical services, but health care practitioners hesitate to address and assess early trauma despite its known negative health effects. This study examines medical students' perspectives on a brief course that addressed the health care needs of patients exposed to adverse childhood experiences. METHODS: A convenience sample of 20 University of California, Davis medical students from the Summer Institute on Race and Health received 6 hours of trauma-informed care training. The course was delivered in 2-hour modules during the course of 3 days, and included lectures, discussions, and practice. A questionnaire assessing students' perspectives on training benefits, current practice challenges, and necessary resources to provide trauma-informed medical care was distributed posttraining. RESULTS: From the students' perspectives, this course increased their ability to recognize various clinical manifestations of adverse childhood experience exposure in adult patients. Students said they learned how to ask about and respond to adverse childhood experience disclosures and identify necessary resources to responsibly implement trauma-informed care in medical settings. Students identified provision of adequate resources and links to appropriate treatment identified as common challenges in providing health care to trauma-affected patients. CONCLUSION: Study findings illustrate that trauma training can fill a knowledge gap and provide associated benefits for medical students. Initial training may pique students' interest by demonstrating the relevance of trauma knowledge in clinical practice; additional training likely is needed to support skills and confidence.

Rethinking the Measurement of Adversity.

Research on adverse childhood experiences (ACEs) has unified the study of interrelated risks and generated insights into the origins of disorder and disease. Ten indicators of child maltreatment and household dysfunction are widely accepted as ACEs, but further progress requires a more systematic approach to conceptualizing and measuring ACEs. Using data from a diverse, low-income sample of women who received home visiting services in Wisconsin ( N = 1,241), this study assessed the prevalence of and interrelations among 10 conventional ACEs and 7 potential ACEs: family financial problems, food insecurity, homelessness, parental absence, parent/sibling death, bullying, and violent crime. Associations between ACEs and two outcomes, perceived stress and smoking, were examined. The factor structure and test-retest reliability of ACEs was also explored. As expected, prevalence rates were high compared to studies of more representative samples. Except for parent/sibling death, all ACEs were intercorrelated and associated at the bivariate level with perceived stress and smoking. Exploratory factor analysis confirmed that conventional ACEs loaded on two factors, child maltreatment and household dysfunction, though a more complex four-factor solution emerged once new ACEs were introduced. All ACEs demonstrated acceptable test-retest reliability. Implications and future directions toward a second generation of ACE research are discussed.

Adverse childhood experiences, health, and employment: A study of men seeking job services.

The present study explored factors associated with barriers to current employment among 199 low-income, primarily Black American men seeking job services. The study took place in an urban setting located within the upper Midwest region of the U.S., where the problem of Black male joblessness is both longstanding and widespread. Recent research suggests that Black male joblessness regionally and nationally is attributable to myriad macro- and micro-level forces. While structural-level factors such as migration of available jobs, incarceration patterns, and racism have been relatively well-studied, less is known about individual-level predictors of Black male joblessness, which are inextricably linked to macro-level or structural barriers. This study therefore examined relations between adverse childhood experiences (ACEs), health-related factors, and employment-related problems. Participants faced both specific and cumulative childhood adversities at much higher rates than men from more economically advantaged contexts. In addition, the physical, behavioral, and mental health of the study participants were, according to self-report survey results, notably worse than that of the general population or alternative samples. Finally, results indicated that exposure to ACEs may have helped to undermine the men's ability to attain current employment and that drug problems along with depression symptoms helped explain the link between ACEs and employment barriers. Theoretical and practical implications of results are explored.

Violent Victimization Among Disadvantaged Young Adults Exposed to Early Family Conflict and Abuse: A 24-Year Prospective Study of the Victimization Cycle Across Gender.

Significant associations between childhood victimization and later revictimization have materialized in previous literature; yet, the victimization cycle has been primarily explored with indicators of sexual assault, although insight into linkages between other forms of victimization remains limited. This study examined connections from family conflict exposure and physical abuse in childhood to violent crime victimization in adulthood, assessing also gender differences and neighborhood influences. Results from logistic regression and hierarchical linear modeling with data from the Chicago Longitudinal Study, a panel of 1,539 low-income, ethnic/racial minority children, unearthed a significant relation between family conflict exposure and later revictimization. Moderated by gender, these analyses showed girls exposed to frequent family conflict are particularly vulnerable to revictimization in adulthood. Exploratory analyses unveiled a potential linkage between childhood physical abuse and later revictimization for men. Neighborhood effects marginally influenced results in one instance. Public health implications are discussed.

Implementation of Parent Child Interaction Therapy Within Foster Care: An Attempt to Translate an Evidence-Based Program Within a Local Child Welfare Agency.

This paper describes an innovative adaptation of an evidence-based intervention - Parent Child Interaction Therapy or PCIT - to foster parent training services. The authors faced multiple problems that commonly plague translational child welfare research as they developed, implemented and tested their model. The paper discusses how the authors addressed these problems when: 1) specifying the child welfare context in which the intervention model was implemented and tested, choosing an intervention model that responded to child welfare service needs, and tailoring the model for a child welfare context; 2) securing external funding and initiating sustainability plans for model uptake; and 3) forging a university-community partnership to overcome logistical and ethical obstacles. Concluding with a summary of promising preliminary study results, a description of future plans to replicate and spread the model, and a distillation of project lessons, the paper suggests that child welfare translational research with PCIT is very promising.

Enhancing Foster Parent Training with Parent-Child Interaction Therapy: Evidence from a Randomized Field Experiment.

OBJECTIVE: Research indicates that foster parents often do not receive sufficient training and support to help them meet the demands of caring for foster children with emotional and behavioral disturbances. Parent-Child Interaction Therapy (PCIT) is a clinically efficacious intervention for child externalizing problems, and it also has been shown to mitigate parenting stress and enhance parenting attitudes and behaviors. However, PCIT is seldom available to foster families, and it rarely has been tested under intervention conditions that are generalizable to community-based child welfare service contexts. To address this gap, PCIT was adapted and implemented in a field experiment using 2 novel approaches-group-based training and telephone consultation-both of which have the potential to be integrated into usual care. METHOD: This study analyzes 129 foster-parent-child dyads who were randomly assigned to 1 of 3 conditions: (a) waitlist control, (b) brief PCIT, and (c) extended PCIT. Self-report and observational data were gathered at multiple time points up to 14 weeks post baseline. RESULTS: Findings from mixed-model, repeated measures analyses indicated that the brief and extended PCIT interventions were associated with a significant decrease in self-reported parenting stress. Results from mixed-effects generalized linear models showed that the interventions also led to significant improvements in observed indicators of positive and negative parenting. The brief course of PCIT was as efficacious as the extended PCIT intervention. CONCLUSIONS: The findings suggest that usual training and support services can be improved upon by introducing foster parents to experiential, interactive PCIT training.