Complex Autism Spectrum Disorder: Structural Determinants of Health and Their Impact on the Diagnosis.

CASE: Emmanuel is a 6.5-year-old boy who was referred to your evaluation clinic for concerns about his social skills and communication. He arrived in the United States (US) 1 year ago after an immigration trajectory that began in Haiti when he was aged 3 years; passed through Mexico, where the family was in various shelters for over a year; and concluded 2 years later, with the family eventually settling in an urban center in the northeastern United States. While in Mexico, the family was living in a camp without access to utilities. They faced significant food insecurity and experienced multiple relocations because of fears of physical safety.Emmanuel's native language is Haitian Creole, but he learned some Spanish during the year spent in Mexico. Now in the United States, he has been enrolled for the last year in the public school system, where he participates in an inclusion English as a Second Language kindergarten classroom. The school has expressed concern about several behaviors including bolting from the classroom, shouting out inappropriately, and taking food from other children's lunches.On initial meeting with a DBP clinician, Emmanuel's parents report that they do not have any concerns at home about his behavior, although they do feel that he "talks less than his 3 older siblings." The 6-person household is currently living in one-room, temporary housing; they deny current food insecurity.As part of his evaluation, you perform an Autism Diagnostic Observation Scale-2 Module 3 in English with the support of an in-person Haitian Creole interpreter. Emmanuel does not make eye contact throughout the evaluation but does respond to your questions in a combination of English and Haitian Creole. He can define the concept of a "friend" but cannot name one of his own friends. He is not able to engage in the demonstration task with words but does use gestures to indicate the actions involved in brushing teeth. His free play is perseverative and centers around fighting between the action figures.Brief cognitive testing reveals normal nonverbal intelligence. He is unable to decode in English on achievement testing. The family completes a Social Responsiveness Scale in English, which shows normal scores except in the repetitive behaviors section, where the family endorses pacing and some restricted interests, particularly around video games.He is not yet on an Individualized Education Plan, and there have been no formal assessments from the school except for language dominance testing indicating that his dominant language is Haitian Creole, with emerging English skills. What specific topics are unique to the evaluation for autism in an English language learner with a significant trauma history? What factors should be considered when assessing a child with a history of immigration trauma?

Trauma, immigration, and sexual health among Latina women: Implications for maternal-child well-being and reproductive justice.

Latina immigrant women are vulnerable to traumatic stress and sexual health disparities. Without autonomy over their reproductive health and related decision-making, reproductive justice is elusive. We analyzed behavioral health data from 175 Latina immigrant participants (M age = 35; range = 18-64) of the International Latino Research Partnership (ILRP) study. We used descriptive and inferential statistics to compare immigrant mothers of minor children to those without, regarding their psychological and reproductive health, and correlates of past exposure to sexual trauma. Over one third (38%) of ILRP participants had minor children, and 58% had citizenship in their host country. The rate for sexual assault was 30 and 61%, respectively, for physical assault; these rates were similarly high for women with and without minor children. Women who reported sexual assault scored significantly higher for depression, posttraumatic stress disorder, and substance-abuse screens. Odds of experiencing sexual assault was highest for women who experienced physical assault (odds ratio = 10.74), and for those from the Northern Triangle (odds ratio = 8.41). Subgroups of Latina migrant mothers are vulnerable to traumatic stress and related sexual and mental health risks. Given these findings, we frame the implications in a reproductive justice framework and consider consequences for caregiver-child well-being.

Trasfondo: Las mujeres latinas inmigrantes son vulnerables al estrés traumático y a las disparidades de salud sexual. Sin autonomía sobre su salud reproductiva y las decisiones que se deben tomar al respecto, la justicia reproductiva es difícil de alcanzar. Métodos: Analizamos información sobre las actitudes con respecto a la salud de parte de 175 inmigrantes latinas participantes (edad promedio 35; entre 18 y 64) del estudio de Investigación Conjunta Internacional de Asuntos Latinos (ILRP). Usamos estadísticas descriptivas y deductivas para comparar las madres inmigrantes de niños menores con aquellas sin ellos, sin tomar en cuenta su salud sicológica y reproductiva, y correlacionar el haber estado expuestas a trauma sexual en el pasado. Resultados: Más de un tercio (38%) de las participantes del grupo de ILRP tenían niños menores, y 58% tenían ciudadanía en el país donde residían. El promedio en cuanto a la agresión sexual fue de 30% y 61% en el caso de agresión física; estos promedios fueron similarmente altos tanto para mujeres con niños pequeños como mujeres sin niños pequeños. Las mujeres que reportaron agresión sexual tuvieron puntajes significativamente más altos en el caso de depresión, trastorno por estrés postraumático (PTSD) y exámenes de detección de abuso de sustancias. Las posibilidades de experimentar agresión sexual fue lo más alto para mujeres que experimentaron agresión física (OR = 10.74), y para aquellas del Triángulo del Norte (OR = 8.41). Conclusiones: Los subgrupos de madres latinas inmigrantes son vulnerables al estrés traumático y los relacionados riesgos de salud sexual y mental. Dados estos resultados, colocamos las implicaciones dentro de un marco de trabajo de justicia reproductiva y consideramos las consecuencias para el bienestar de quien le presta cuidados al niño.

Contexte Les femmes immigrées latinas sont vulnérables au stress traumatique et aux disparités de santé sexuelle. Sans autonomie quant à leur santé reproductive et les décisions qui y sont liées, leur justice reproductive est insaisissable. Méthodes Nous avons analysé des données de santé comportementale de 175 participantes immigrées (moyenne d'âge 35 ans; éventail de 18 à 64 ans) de l'étude du partenariat de recherche international International Latino Research Partnership (ILRP). Nous avons utilisé des statistiques descriptives et déductives pour comparer les mères immigrées d'enfants mineurs à celles sans enfants, pour ce qui concerne leur santé psychologique et reproductive, ainsi que les corrélats d'exposition à un trauma sexuel dans le passé. Résultats Plus d'un tiers (38%) des participantes ILRP avaient des enfants mineurs et 58% détenaient la citoyenneté dans leur pays d'accueil. Le taux de violences sexuelles était de 30% et de 61% pour les aggressions physiques. Ces taux étaient aussi élevés chez les femmes avec ou sans enfants mineurs. Les femmes ayant déclaré des violences sexuelles ont fait état de scores bien plus élevés pour la dépression, le TSPT et la toxicomanie. Les probabilités de faire face à des violences sexuelles étaient les plus élevées chez les femmes ayant vécu une aggression physique (OR = 10,74), et pour celles du Triangle du Nord de l'Amérique centrale (OR = 8,41). Conclusions Des sous-groupes de mères migrantes latinas sont vulnérables au stress traumatique et à des risques de santé mentale qui y sont liés. Au vu de ces résultats, nous encadrons les implications dans une structure de justice de reproduction et considérons les conséquences pour le bien-être mère-enfant.

Screening for Trauma Symptoms in Child Welfare-Involved Young Children: Findings from a Statewide Trauma-Informed Care Initiative.

Young children who experience abuse, neglect, domestic violence, and other interpersonal forms of trauma are at risk for developing complex psychological trauma. Timely referrals by child welfare services for trauma evaluation and intervention is critical, particularly during the developmentally-sensitive period of birth to three. However, few screening instruments exist that are feasible for implementation in child welfare services and none have reported psychometric data for children under three. The aim of this exploratory, retrospective study was to examine developmental differences in detection rates of two brief trauma screening scales, comparing outcomes for toddlers (age 1 and 2 years) and preschoolers (age 3 to 6 years), using the evaluation data from a statewide child welfare demonstration project. The sample included 151 children ages 1 to 6 participating in evidence-based trauma treatment with their caregivers. More than 80% of children, regardless of age group, met the cut-off on one of the screeners; children who met the cut-off on either screener were significantly more likely to have experienced domestic violence, physical abuse or poly-victimization. Implications for future research are discussed.

The impact of a statewide trauma-informed child welfare initiative on children's permanency and maltreatment outcomes.

This article presents findings of a state-wide trauma informed child-welfare initiative with the goal of improving well-being, permanency and maltreatment outcomes for traumatized children. The Massachuetts Child Trauma Project (MCTP), funded by the Administration of Children and Families, Children's Bureau was a multi-year project implementing trauma-informed care into child welfare service delivery. The project's implementation design included training and consultation for mental health providers in three evidence-based treatments and training of the child-welfare workforce in trauma-informed case work practice. The learning was integrated between child-welfare and mental health with Trauma Informed Leadership Teams which included leaders from both systems and the greater community. These teams developed incremental steps toward trauma-informed system improvement. This study evaluated whether MCTP was associated with reductions in child abuse and neglect, improvements in placement stability, and higher rates of permanency during the first year of implementation. Children in the intervention group had fewer total substantiated reports of maltreatment, including less physical abuse and neglect than the comparison group by the end of the intervention year. However, children in the intervention group had more maltreatment reports (substantiated or not) and total out-of-home placements than did their counterparts in the comparison group. Assignment to MCTP, however, was not associated with an increase in kinship care or adoption. Overall, the results are promising in reinforcing the importance of mobilizing communities toward improvements in child-welfare service delivery.

IMPLEMENTATION AND SUSTAINABILITY OF CHILD-PARENT PSYCHOTHERAPY: THE ROLE OF REFLECTIVE CONSULTATION IN THE LEARNING COLLABORATIVE MODEL.

Recent implementation science in mental health has focused on identifying the most effective strategies to disseminate and implement evidence-based treatments (EBTs) into real-world practice settings. The learning collaborative training methodology and its use of expert trainers/consultants have become increasingly popular as one of these approaches. Moreover, there is preliminary evidence that ongoing expert consultation may increase the adoption, learning, and sustainability of EBTs by an already practicing workforce and, consequently, help trainers, practitioners, and organizations address implementation barriers. This article describes the authors' experiences in facilitating Child-Parent Psychotherapy (CPP) training and explores the role of reflective clinical consultation as an active process that supports the implementation of a rich, but complex, model that requires sophisticated knowledge and skills from practitioners. It examines the intricate range of the CPP consultant's functions, which ultimately support clinicians' reflective practice as they learn and adopt this EBT. Reflective consultation is proposed as an essential component for the integration of knowledge, experience, and emotions in practitioners and as a catalyst for organizational change. Using their voices as trainers-consultants and those of their trainees, the authors discuss the implications of reflective consultation for the effective implementation and sustainability of CPP. Reflections are offered on lessons learned.