"You're going to look at me differently": A qualitative study of disclosure experiences among survivors of military sexual assault.

Most survivors of sexual assault who disclose their experience do so within their social network. Prior research on disclosure among individuals who experience sexual trauma has mainly focused on childhood sexual abuse, college-aged women, or disclosure to formal sources of support (e.g., treatment providers). There is limited research on disclosure among veteran survivors of military sexual assault (MSA). The current qualitative study aimed to explore the disclosure experiences of treatment-seeking survivors of MSA. Participants were 17 veterans (n = 13 women, n = 4 men), aged 33-65 years, who reported experiencing MSA. During semistructured interviews, participants were asked about their experiences disclosing MSA to informal support persons (e.g., family members, partners, friends). A narrative thematic analysis identified 11 themes that emerged throughout different aspects of the disclosure, including (a) preparation and reason for disclosure (reactive or spontaneous disclosures, disclosure as an explanation/obligation), (b) expectations about the disclosure experience (no expectations, negative expectations grounded in socialized beliefs, positive expectations based on specific relationships, mismatch between experience and expectation), (c) the actual disclosure experience (negative experiences of personalization, supportive responses, share shame), and (d) military context (disclosing to another member of the military, reporting dynamics). Additional subthemes were nested within these categories. The findings indicated common experiences across participants, particularly regarding disclosure rationale. Key differences were largely influenced by contextual factors (e.g., response of the disclosure recipient). These findings hold implications for clinicians working with survivors of MSA who are preparing for and coping with the consequences of disclosure.

Exposure therapy for PTSD during pregnancy: a feasibility, acceptability, and case series study of Narrative Exposure Therapy (NET).

BACKGROUND: Prenatal posttraumatic stress disorder (PTSD) is a significant complication of pregnancy linked to increased risk of adverse perinatal outcomes. Although 1 in 5 pregnant trauma-exposed individuals have PTSD, most PTSD treatment trials exclude participants who are pregnant, and none focus on treatment specifically during pregnancy. Moreover, access to mental health treatment is particularly challenging in low-resource settings with high rates of trauma. This study examined implementation of Narrative Exposure Therapy (NET), a short-term evidence-based PTSD treatment, in an urban prenatal care setting. Partial telehealth delivery was used to increase accessibility. Study aims were to examine (a) feasibility, (b) acceptability, and (c) case-based treatment outcomes associated with NET participation. METHOD: Eight pregnant participants (median age = 27, median gestational week in pregnancy = 22.5) received up to six sessions of NET with partial telehealth delivery. PTSD and depression symptoms were assessed at pre-treatment intake (T1), at each session (T2), and 1-week post-treatment (T3). A multiple case study approach was used to examine recruitment and engagement, retention, treatment completion, treatment barriers, use of telehealth, participants' experiences of treatment, and PTSD and depression symptoms. RESULTS: Nine of the 16 participants (56%) who were invited to participate engaged in treatment, and one dropped out after the first session. Eight participants completed the minimum "dose" of 4 NET sessions (N = 8/9, 89%). Seven participants gave the highest ratings of treatment acceptability. The most frequently reported barriers to treatment were competing priorities of work and caring for other children. Pre-post treatment symptom measures revealed clinically meaningful change in PTSD severity for nearly all participants (7/8, 88%). CONCLUSIONS: Results suggest that a brief exposure therapy PTSD treatment can be successfully implemented during pregnancy, suggesting promising results for conducting a larger-scale investigation. Trial registration ClinicalTrials.gov, NCT04525469. Registered 20 August 2020-Retrospectively registered, https://register.clinicaltrials.gov/prs/app/template/EditRecord.vm?epmode=View&listmode=Edit&uid=U00058T2&ts=3&sid=S000A59A&cx=-w1vnvn.

Improving outcomes for a 3-week intensive treatment program for posttraumatic stress disorder in survivors of military sexual trauma.

BACKGROUND: The experience of Military Sexual Trauma (MST) in the form of sexual assault and sexual harassment is common during service in the U.S. Armed Forces and often leads to adverse health outcomes including posttraumatic stress disorder (PTSD). Improving treatment of MST-related PTSD across settings is important to optimize treatment for survivors. The delivery of Cognitive Processing Therapy (CPT) in an intensive treatment program (ITP) shows promise for rapid reduction of PTSD symptoms for veterans and service members (veterans). However, a recent outcome study suggested that this modality is significantly less effective in reducing symptoms of PTSD for survivors of MST compared to veterans recovering from combat trauma. METHODS: -The current study examines the utility of modifications made to a CPT-based ITP designed to treat PTSD secondary to MST in a mixedgender sample (N = 285). Treatment modifications included the introduction of skills-based groups in emotion regulation and interpersonal domains. Individual skills-consultation sessions were also offered to participants on an as-needed basis. Further, training was provided to both clinical and non-clinical staff to increase understanding of the unique experiences and needs of MST survivors. RESULTS: Program changes proved beneficial, resulting in PTSD treatment outcomes that were comparable for survivors of MST and combat traumas. LIMITATIONS: Further research is needed to determine which of these specific program changes were most impactful in improving symptom outcomes. CONCLUSIONS: Our findings suggest that short-term, intensive PTSD treatment for MST survivors may be improved by integrating present-focused, skills-based therapies and staff sensitivity training.

Assessing and treating complex mental health needs among homeless youth in a shelter-based clinic.

BACKGROUND: Rates of homelessness have been increasing in recent years, thereby necessitating a more direct approach to treating this complex social problem. Homeless youth have disproportionately high rates of untreated mental health problems and are therefore particularly vulnerable to the effects of homelessness during the transition period from adolescence to adulthood. METHODS: The study team developed a shelter-based clinic and collected clinical measures on youth who attended this clinic from October 2016 through June 2018. RESULTS: Youth attended an average number of three sessions, but there was a significant drop in follow-up after the first (intake) appointment. Depression, anger, and adjustment disorder emerged as the most common presenting mental health concerns identified by clinicians in the intake appointment, and trauma was identified as a significant complaint for those youth who returned for a second session. CONCLUSION: Mental health care is needed in this population, but future studies should explore alternative approaches to retaining homeless youth in treatment and in designing targeted trauma-informed interventions.

A Mobile Phone-Based Intervention to Improve Mental Health Among Homeless Young Adults: Pilot Feasibility Trial.

BACKGROUND: Youth homelessness is a substantial issue, and many youths experiencing homelessness have mental health issues as both a cause and consequence of homelessness. These youths face many barriers to receiving traditional mental health services, and as a result, only a few youths experiencing homelessness receive any form of mental health care. OBJECTIVE: This project aimed to develop and determine the feasibility and acceptability of engaging young adults (ie, individuals aged 18-24 years) experiencing homelessness in a remotely delivered mental health intervention. This intervention provided brief emotional support and coping skills, drawing from cognitive behavioral principles as an introduction into psychosocial support. The intervention was piloted in a homeless shelter network. METHODS: A total of 35 young adults experiencing homelessness participated in a single-arm feasibility pilot trial. Participants received a mobile phone, a service and data plan, and 1 month of support from a coach consisting of up to 3 brief phone sessions, text messaging, and mobile mental health apps. We evaluated feasibility by looking at completion of sessions as well as the overall program and acceptability with satisfaction ratings. We also collected clinical symptoms at baseline and the end of the 1-month support period. We used validity items to identify participants who might be responding inappropriately and thus only report satisfaction ratings and clinical outcomes from valid responses. RESULTS: Most participants (20/35, 57%) completed all 3 of their phone sessions, with an average of 2.09 sessions (SD 1.22) completed by each participant. Participants sent an average of 15.06 text messages (SD 12.62) and received an average of 19.34 messages (SD 12.70). We found higher rates of satisfaction among the participants with valid responses, with 100% (23/23) of such participants indicating that they would recommend participation to someone else and 52% (12/23) reporting that they were very or extremely satisfied with their participation. We found very little change from pre- to posttreatment on measures of depression (d=0.27), post-traumatic stress disorder (d=0.17), and emotion regulation (d=0.10). CONCLUSIONS: This study demonstrated that it was feasible to engage homeless young adults in mental health services in this technology-based intervention with high rates of satisfaction. We did not find changes in clinical outcomes; however, we had a small sample size and a brief intervention. Technology might be an important avenue to reach young adults experiencing homelessness, but additional work could explore proper interventions to deliver with such a platform. TRIAL REGISTRATION: ClinicalTrials.gov NCT03620682; https://clinicaltrials.gov/ct2/show/NCT03620682.

Housing decisions among homeless families involved in the child welfare system.

The present study embedded a qualitative sub-study within a randomized controlled trial of housing services for child welfare-involved families to examine housing decisions made in the face of homelessness and child protection. Participants included a representative sample of caregivers (n = 19) randomized to receive the Family Unification Program - a permanent housing intervention for inadequately housed families under investigation for child abuse or neglect - or child welfare services-as-usual. Qualitative interviews 12 months after randomization assessed housing decision-making processes involved in keeping families safe and stable. Results indicated a push-pull dynamic that constrained housing choices regardless of whether permanent housing was made available. Caregiver housing decisions were constrained by time limitations, affordability, and access to services, while child and family safety was perceived as less important. Findings emphasize the need for housing informed child welfare services to ensure the long-term safety of children in families experiencing homelessness.

Kinship foster care among African American youth: Interaction effects at multiple contextual levels.

This study investigated the effects of kinship foster care on mental health outcomes among African American youth. Longitudinal data were used from a nationally representative sample of children and adolescents who were the subject of child protective services investigation from 1999 to 2000 (n=5,501). The secondary analyses focused on African American youth (n=225) placed into foster care. In structured interviews, current caregivers reported on youth internalizing and externalizing behaviors immediately following placement into out-of-home care and 18-months later. Path analysis tested a theoretical model that compared placements with kin to other formal out-of-home arrangements in context of setting characteristics, including aspects of caregiver and neighborhood disorder. Results suggested significant increases in internalizing symptoms over time for youth with more baseline mental health problems, as well as those placed in more distressed neighborhoods. Increased externalizing symptoms occurred among youth with greater baseline behavior problems, those placed in more problematic neighborhoods, and youth who experienced a placement change between assessments. Additionally, a combination of placement characteristics predicted increases in externalizing problems; youth placed in kinship foster care with older caregivers in poorer health exhibited greater increases in externalizing problems. Findings highlighted important contextual considerations for out-of-home placement among African American youth.

Social justice and religious participation: a qualitative investigation of Christian perspectives.

This investigation examines how self-identified Christians in the Midwest U.S. understand and work for social justice, with a focus on their process of social justice development and the role of religious congregations in promoting social justice. Using a grounded theory analysis of 15 in-depth interviews, results indicated multiple understandings of social justice such as meeting basic needs, fixing social structures and systems to create equal distributions of resources, promoting human rights and dignity, and as a religious responsibility. Participants also described a process of social justice development facilitated by exposure to injustice, mentors, educating others, and the importance of finding a social justice community. Distinct personal barriers to social justice engagement were identified such as resources and negative emotions, whereas congregational leadership was important for congregational involvement. General frustration with congregations was expressed regarding low social justice engagement; however, participants balanced this frustration with hope for the positive potential of congregations to promote social justice. Together these findings show multifaceted understandings of social justice and a dynamic process of social justice development for these self-identified Christians. Implications for future research and partnership with religious individuals and congregations also are discussed.

Housing services for child welfare-involved families: an initial evaluation using observational data.

This study evaluated the impact of housing services among child welfare-involved families using observational data. Propensity score matching with data from the National Survey of Child and Adolescent Well-Being compared intact families (n = 183) who received housing services 12 months after initial investigation to nontreated families balanced on characteristics at the time of investigation. Results suggested that general housing services failed, on average, to effectively address the needs of inadequately housed families.