Trauma-informed care in school-based health centers: A mixed methods study of behavioral health screening and services.

An explanatory, parallel mixed method design was used to examine trauma screening and behavioral health service rates in urban school-based health centers (SBHCs) and SBHC personnel's experiences providing culturally responsive, trauma-informed care. Logistic regressions were performed with electronic medical records from N = 4,794 patients ages 12-22 receiving care in a SBHC using trauma screening rates and service use as dependent variables. Quantitative analyses were supplemented with semistructured interviews with medical providers and behavioral health clinicians (N = 9) from eight SBHCs. The overall trauma screening rate across the SBHCs was 69.2%. Screening rates were higher for older and Spanish-speaking youth. The rate of behavioral health use was 32.9%, with higher rates among students screened for trauma at a prior medical visit, recent immigrant, and female youth. This suggests that trauma screening is feasible and facilitates access. Additionally, English-speaking youth were more likely to use behavioral health services than Spanish-speakers. Qualitative analyses suggested a strong sense of mission, collaboration, and beliefs that trauma screening facilitated access to care all facilitated trauma-focused screening. Barriers included staffing shortages and language translation challenges. Analysis also highlighted the importance of culturally responsive practices (e.g., interpreters, culture-specific assessment tools, knowledge of population needs). Mixed methods integrative analysis highlighted the ways in which barriers and facilitators aligned with the overall rates of access to screening and behavioral health care, and factors that helped the SBHCs tailor care to diverse youth. Limitations and implications for practice are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

When silence feels safer: Challenges and successes of delivering a school-based cognitive behavioral intervention to Central American unaccompanied immigrant youth.

OBJECTIVE: To explore cultural and immigration-related factors, among Central American unaccompanied immigrant youth (UIY), affecting the safety and acceptability of Cognitive Behavioral Intervention for Trauma in Schools (CBITS), a group intervention designed to treat trauma symptoms. METHOD: Thematic analysis of data from grounded theory study of group interventions to support resilience in UIY, consisting of interviews with 10 key stakeholders (5 CBITS facilitators) and 16 UIY (6 CBITS participants) from El Salvador, Guatemala, or Honduras, interviews conducted in Spanish, English, or Mam. RESULTS: Five themes emerged from interviews with CBITS facilitators and UIY: (a) Todo está bién: self-protective silence about trauma and symptom denial, (b) Chisme goes around: personal risks of disclosure, (c) marginalizing the language and world view of indigenous youth, (d) "CBITS didn't really quite land for them": adapting the curriculum and delivery, and (e) "I learn to appreciate things": benefits of the CBITS group. CBITS facilitators endorsed skill-building aspects of the groups and expressed concerns about a curriculum relying on written homework and parental support for youth with limited home country schooling, currently living with distant relatives. CBITS participants endorsed hearing about other youths' stories and learning coping skills. CONCLUSIONS: Models for group intervention that emphasize coping skill development and group support, while de-emphasizing the trauma narrative, should be explored and tested. Group intervention leaders should consider the impact of differences in gender, country of origin, and native language on group dynamics. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Trauma in Schools: An Examination of Trauma Screening and Linkage to Behavioral Health Care in School-Based Health Centers.

BACKGROUND: This study examined trauma screening and behavioral health linkage rates in school-based health centers (SBHCs). METHODS: Participants included 4161 English- and Spanish-speaking patients between the ages of 12 and 22 across 8 urban SBHCs 2 years. Screening rates at medical visits and linkage to additional behavioral health screening and services were assessed via electronic medical records and a chart audit. RESULTS: Medical providers administered the Primary Care-PTSD screen to 66.3% of patients in year 1 and 46.7% of patients in year 2. Rates of positive trauma screens were 27.5% and 32.1%, respectively, with more girls screening positive than boys. Few (year 1; 8.1%; year 2: 9.6%) adolescents received additional trauma screening by a behavioral health clinician. However, the majority were linked to services (year 1: 66%; year 2: 74%). Lack of documentation (year 1: 24%; year 2: 33%) was a common gap in the charts of patients who did not receive a second stage trauma screening. Demographic differences in screening rates were minimal. CONCLUSION: The current study supports the feasibility of traumatic stress screening and linkage within an integrated care setting. Process improvement efforts should, however, address communication gaps around trauma assessment and its integration into ongoing care.