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1.
J Trauma Stress ; 37(2): 267-279, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38196345

RESUMEN

Youth exposed to natural disasters are at risk of developing trauma-related symptoms as well as engaging in substance use. Although previous research has established associations between disaster-related stressors and substance use in youth, less has focused on how symptoms of posttraumatic stress disorder (PTSD) may underpin this association. The current study used network analysis to identify specific PTSD symptoms associated with substance use following a natural disaster. Participants were 91,732 youths (Grades 3-12) from across Puerto Rico who completed a needs assessment 5-9 months after Hurricane Maria made landfall in September 2017. We examined associations between PTSD symptoms and substance use, identified clusters of symptoms and bridges between them, and explored age- and binary gender-related differences in associations between specific PTSD symptoms and substance use. Analyses identified two symptom communities: (a) arousal and reactivity, negative alterations in cognition and mood, and substance use, and (b) avoidance and intrusion. Broader findings suggested that substance use was most strongly associated with PTSD-related irritability and angry outbursts among youths. Surrounding nodes explained only 4.1% of the variance in substance use, but this was higher among youths who reported not having a supportive adult, R2 = 8.5; friend, R2 = 7.9; or teacher/counselor, R2 = 7.7, in their life. The bridge symptoms of sleep disruption and physiological reactivity were identified as potentially critical intervention targets for disrupting PTSD symptom networks after a natural disaster. Implications for triaged mental health care following natural disasters and directions for future research are discussed.


Asunto(s)
Tormentas Ciclónicas , Desastres Naturales , Trastornos por Estrés Postraumático , Trastornos Relacionados con Sustancias , Adulto , Humanos , Adolescente , Trastornos por Estrés Postraumático/psicología , Hispánicos o Latinos/psicología , Trastornos Relacionados con Sustancias/epidemiología
2.
J Trauma Stress ; 36(6): 1066-1076, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37782477

RESUMEN

The purpose of the study was to assess the prevalence rates of anxiety, depression, and posttraumatic stress disorder (PTSD) outcomes among teachers (N = 8,167) exposed to Hurricane Maria in Puerto Rico. The findings indicate that the rates of likely significant symptoms of anxiety, depression, and PTSD were 13.1%, 8.7%, and 5.4%, respectively. There were no significant disparities in psychopathological symptoms based on sex, except that female participants were more likely to exhibit anxiety symptoms than their male counterparts, odds ratio (OR) = 1.53. Key disaster-related factors, such as perceived threat, actual threat, and disruption of life were found to significantly influence all psychopathology outcomes, ORs = 1.20-3.57, whereas increased social support significantly buffered the manifestation of clinically significant psychopathology symptoms across all domains, ORs = 0.30-0.46. These outcomes, strongly linked to peritraumatic consequences, were not constrained by geographical or socioeconomic boundaries, highlighting the wide-ranging impact of the hurricane. Nevertheless, social support emerged as a significant counteracting force, reducing the likelihood of detrimental mental health symptoms. Consistent with prior studies, this study emphasizes the crucial role of social support in nurturing posttraumatic resilience and curbing the severity of posttraumatic stress outcomes, thus underscoring the need for incorporating robust social support systems within disaster response strategies.


Asunto(s)
Tormentas Ciclónicas , Desastres , Maestros , Trastornos por Estrés Postraumático , Femenino , Humanos , Masculino , Hispánicos o Latinos/psicología , Salud Mental , Trastornos por Estrés Postraumático/psicología , Maestros/psicología
3.
Artículo en Inglés | MEDLINE | ID: mdl-37646966

RESUMEN

Implementation science is the scientific study of methods to promote the uptake of research findings and other evidence-based practices in routine care, with the goal of improving the quality and effectiveness of health services (Bauer et al., 2015). In addition to this common goal, practice-oriented psychotherapy research (and researchers) and implementation science (and scientists) share a common focus on the people and the places where treatment happens. Thus, there exists strong potential for combining these two approaches. In this article, we provide a primer on implementation science for psychotherapy researchers and highlight important areas and examples of convergence and complementarity between implementation science and practice-oriented psychotherapy research. Specifically, we (a) define and describe the core features of implementation science; (b) discuss similarities and areas of complementarity between implementation science and practice-oriented psychotherapy research; (c) discuss a case example that exemplifies the integration of implementation science and practice-oriented research; and (d) propose directions for future research and collaborations that leverage both implementation science and practice-oriented research.

4.
Adm Policy Ment Health ; 50(5): 781-791, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37347371

RESUMEN

Empirically supported interventions are warranted to achieve desired clinical outcomes and improve service delivery. Thus, efforts to identify, adopt, and implement Evidence-Based Practices (EBPs) are underway across various Latinx communities, including Puerto Ricans, where there is a growing recognition and prevalence of mental health and substance use disorders. This study investigated the needs and attitudes toward EBPs among an interdisciplinary sample of mental health professionals in Puerto Rico. An anonymous survey was distributed to social workers, psychologists, and professional counselors (N = 237). Using structural equation modeling, four dimensions of attitudes towards EBPs (openness, divergence, appeal, and requirement) were regressed on various individual and organizational factors. Some socio-demographic characteristics, educational opportunities, and organizational factors significantly contributed to specific attitudes related to the adoption of EBPs. Female participants and those working in rural settings scored higher in the openness to innovation dimension. Greater organizational support and graduating from a private institution were associated with more divergence from research, while married individuals and those trained on EBPs scored lower on this dimension. The lack of exposure to EBPs in college and younger age predicted greater interest in the appeal of adopting an EBP intervention (i.e., would adopt an EBP if it made sense). No differences in attitudes toward EBPs were found by professional discipline or work setting (i.e., clinical, community, and schools). Recommendations to increase openness and interest in the appeal of EBPs among Spanish-speaking professional communities in Latin America are highlighted.


Asunto(s)
Práctica Clínica Basada en la Evidencia , Salud Mental , Humanos , Femenino , Actitud del Personal de Salud , Encuestas y Cuestionarios , Instituciones Académicas
5.
Psychol Serv ; 20(1): 107-121, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-34968120

RESUMEN

Telehealth services can address many barriers to traditional office-based mental health services. Few studies have assessed youth and caregiver perceptions of and satisfaction with trauma-focused interventions delivered via telemental health. The present study reports data collected using the Telehealth Satisfaction Questionnaire (TSQ), which was developed to measure child and caregiver satisfaction with services, comfort with the telehealth equipment, and barriers to traditional office-based services. Thirteen clinicians delivered home- and school-based Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) via videoconferencing on tablets and computers to 60 child patients (71.7% Latinx, 18.3% Black, and 10.0% non-Hispanic White). Patients and caregivers completed the TSQ at treatment discharge via telephone, videoconferencing, or in-person interviews. There was a high level of satisfaction among patients and caregivers receiving TF-CBT via telemental health. Furthermore, most youth and caregivers felt comfortable using the telehealth equipment from the outset of therapy, and all participants who were not initially comfortable using the equipment reported feeling more comfortable over time. The most common barriers to traditional office-based services were caregiver work schedule (57.7%), distance to mental health clinic (55.8%), and lack of transportation (44.2%). Patients and caregivers expressed a preference for telemental health services if given the option between receiving therapy via videoconferencing versus going to an office-based clinic. Findings indicated telemental health treatment addressed barriers that would have otherwise prevented families from accessing office-based services. The TSQ can be used to help clinics and providers assess patient and caregiver satisfaction with telehealth services in various settings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Asunto(s)
Terapia Cognitivo-Conductual , Servicios de Salud Mental , Telemedicina , Niño , Adolescente , Humanos , Satisfacción del Paciente , Cuidadores/psicología
6.
Child Abuse Negl ; 129: 105671, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35580399

RESUMEN

PURPOSE: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has not yet been systematically evaluated in the Caribbean context, particularly with Hispanic youth exposed to multiple disasters. The objective of this project was twofold: 1) to train mental health providers in Puerto Rico in TF-CBT as part of a clinical implementation project within the largest managed behavioral health organization (MBHO) on the island, and 2) to conduct a program evaluation to determine the feasibility of implementation and the effectiveness of the treatment. METHOD: Fifteen psychologists were trained in TF-CBT. These psychologists then provided TF-CBT to 56 children and adolescents, ages 5-18, in community-based mental health clinics and one primary care clinic with a co-located psychologist in Puerto Rico. The mean number of traumatic events reported by youth referred for TF-CBT was 4.11. RESULTS: Thirty-six out of 56 children enrolled in the project (64.3%) successfully completed all components of TF-CBT. Results demonstrated large effect sizes for reduction in youth-reported posttraumatic stress symptoms (PTSS) (Cohen's d = 1.32), depressive symptoms (Cohen's d = 1.32), and anxiety symptoms (Cohen's d = 1.18). CONCLUSIONS: These results suggest that it was feasible to train providers in TF-CBT, that providers were able to deliver TF-CBT in community-based settings both in person and via telehealth (due to the COVID-19 pandemic), and that TF-CBT was an effective treatment option to address trauma-related concerns for youth in Puerto Rico in a post-disaster context. This project is an important first step in the dissemination and implementation of evidence-based trauma-focused treatment for Hispanic youth and disaster-affected youth in the Caribbean.


Asunto(s)
COVID-19 , Terapia Cognitivo-Conductual , Desastres , Trastornos por Estrés Postraumático , Adolescente , Niño , Preescolar , Terapia Cognitivo-Conductual/métodos , Hispánicos o Latinos , Humanos , Pandemias , Evaluación de Programas y Proyectos de Salud , Puerto Rico/epidemiología , Trastornos por Estrés Postraumático/psicología
7.
J Trauma Stress ; 35(5): 1559-1570, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-35460129

RESUMEN

Conducting research in global applied settings necessitates the use of easily administered, brief, and evidentiary measures. One widely used, brief self-report measure of posttraumatic stress disorder (PTSD) symptoms in children and adolescents is the Child PTSD Symptom Scale for DSM-5-Self-Report (CPSS-5-SR). The present study examined the factor structure, measurement invariance, reliability, and convergent validity of the Spanish translation of the CPSS-5-SR in a sample of 1,296 third- through 12th-graders in El Salvador (Mage = 12.73 years, SD = 2.67, 55.2% female, 100.0% Latinx). This sample was collected as part of a government-led initiative to conduct broad school-based psychopathology screening, with the wider goal of introducing trauma-informed services into El Salvador's school system. Consistent with prior research, confirmatory factor analysis indicated that the four-factor DSM-5 model displayed a strong fit with the data. Measurement invariance by gender was also examined, with results showing invariance at the configural, metric, and scalar levels, indicating strong evidence that participants' patterns of response did not differ by gender. The results also indicated strong reliability, Cronbach's α = .91, and convergent validity with measures of commonly comorbid psychopathology, rs = .43-.68. Total scale norms derived from the current sample are provided. These findings highlight the considerable levels of posttraumatic stress experienced by Salvadorian youth and the importance of establishing evidentiary measures of psychopathology that can be used in diverse global populations. In particular, psychometric research represents the first step in augmenting efforts to screen, refer, and treat youth impacted by violence across the globe.


Asunto(s)
Trastornos por Estrés Postraumático , Adolescente , Niño , El Salvador , Femenino , Humanos , Masculino , Psicometría/métodos , Reproducibilidad de los Resultados , Autoinforme , Trastornos por Estrés Postraumático/diagnóstico
8.
Child Abuse Negl ; 125: 105488, 2022 03.
Artículo en Inglés | MEDLINE | ID: mdl-35033937

RESUMEN

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.


Asunto(s)
Cuidadores , Abuso Sexual Infantil , Cuidadores/psicología , Niño , Abuso Sexual Infantil/psicología , Femenino , Humanos , Lenguaje , Madres/psicología , Psicometría , Encuestas y Cuestionarios , Estados Unidos
9.
J Child Adolesc Trauma ; 14(3): 433-441, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34471458

RESUMEN

Central American youth are at a high risk for experiencing trauma and related psychosocial problems. Despite this, few studies of evidence-based trauma-focused interventions with this population exist. The objective of this project was twofold: 1) to train providers in El Salvador in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) as part of a clinical implementation project within a non-governmental organization, and 2) to conduct program evaluation to determine the feasibility of implementation and the effectiveness of the treatment. Fifteen Salvadoran psychologists were trained in TF-CBT who then provided TF-CBT to 121 children and adolescents ages 3-18 in community-based locations. The mean number of traumas reported by youth was 4.39. Results demonstrated large effect sizes for reduction in youth-reported trauma symptoms (Cohen's d = 2.04), depressive symptoms (Cohen's d = 1.68), and anxiety symptoms (Cohen's d = 1.67). Our program evaluation results suggest that it was feasible to train providers in TF-CBT, that providers were in turn able to deliver TF-CBT in community-based settings, and that TF-CBT was an effective treatment option to address trauma-related concerns for youth in El Salvador. This project is an important first step in the dissemination and implementation of evidence-based trauma-focused treatment for youth in Latin American countries.

10.
J Trauma Stress ; 34(5): 955-966, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34297864

RESUMEN

Salvadoran youth have an elevated risk of trauma exposure and related mental health problems. However, investigations of childhood trauma exposure and mental health sequelae in El Salvador are limited. The present study aimed to (a) explore the prevalence of exposure to potentially traumatic events and symptoms of posttraumatic stress, anxiety, and depression and (b) evaluate the associations between specific trauma types and emotional functioning among Salvadoran youth. A total of 1,296 youth aged 8-21 years from seven public schools completed self-report measures of trauma exposure, posttraumatic stress symptoms (PTSS), anxiety, and depression. Participants reported high levels of trauma exposure, endorsing an average of 3.62 (SD = 2.32) trauma types. In total, 34.5% of participants reported clinically elevated PTSS; fewer youths reported elevated depressive (8.7%) and anxiety symptoms (8.6%). Although boys reported exposure to more trauma types than girls, d = 0.22, girls were more likely to endorse elevated PTSS, V = .11; anxiety, V = .06; and depression, V = .10. Adolescents reported exposure to more trauma types than younger children, d = 0.23, and were more likely to endorse elevated PTSS, V = .07; anxiety, V = .13; and depression, V = .16. Undergoing a frightening medical procedure, OR = 2.30; female sex, OR = 1.92; witnessing domestic violence, OR = 1.70; and experiencing war between gangs, OR = 1.61, were strong predictors of elevated PTSS. This broad, school-based screening was a critical step toward better understanding the rate of trauma exposure and trauma-related symptoms among Salvadoran youth.


Asunto(s)
Salud Mental , Trastornos por Estrés Postraumático , Adolescente , Niño , El Salvador/epidemiología , Femenino , Humanos , Masculino , Proyectos Piloto , Instituciones Académicas , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/epidemiología , Adulto Joven
11.
J Emerg Manag ; 19(8 (Spec Issue on Puerto Rico)): 167-175, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-36239506

RESUMEN

OBJECTIVE: The increased risk of mental health disorders in the months and years following a natural disaster highlights the need for more immediate preventive intervention. The objective of the current study was to learn from a real-time implementation of a natural disaster response following the Hurricane Maria in Puerto Rico to identify strategies for providing mental health services immediately after a natural disaster. METHODS: Two focus groups were held with faculty (n = 6) and graduate students (n = 4) from a graduate psychology program at the Universidad Carlos Albizu, Centro Universitario Mayagüez. An additional key informant interview was conducted with two faculty member participants. Data were analyzed qualitatively using thematic analysis. RESULTS: The delivery of mental health services was organized into three major themes: (1) finding a way to communicate, (2) targeting key access points for outreach and centralization of resources, and (3) providing triaged mental health care based on level of need. CONCLUSIONS: Findings are used to guide recommendations for mental health response preparation in future natural disaster contexts.


Asunto(s)
Tormentas Ciclónicas , Servicios de Salud Mental , Desastres Naturales , Humanos , Salud Mental , Puerto Rico
12.
J Interpers Violence ; 36(15-16): 7090-7109, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-30827141

RESUMEN

African American youth are disproportionately represented among trauma-exposed youth; yet, they are significantly less likely to access and complete mental health services. Research suggests that barriers to accessing and engaging in trauma-focused treatment include both logistical factors and engagement factors. This multiple case study sought to illustrate the initial feasibility and acceptability of delivering culturally tailored, trauma-focused cognitive behavioral therapy (TF-CBT) via telehealth in a school setting with three African American youth presenting with multiple barriers to accessing treatment. Barriers to treatment, telehealth modifications, and cultural tailoring are described for each participant. The UCLA Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) was completed at pretreatment and posttreatment. Results demonstrated significant decreases in symptoms of posttraumatic stress, as evidenced by a reduction in total UCLA PTSD-RI scores to nonclinical levels for all participants at posttreatment (UCLA scores posttreatment = 8-12). In addition, at posttreatment no participants met diagnostic criteria for PTSD or adjustment disorder. This multiple case study provides preliminary support for school-based, culturally tailored TF-CBT delivered via telehealth with African American youth.


Asunto(s)
Terapia Cognitivo-Conductual , Trastornos por Estrés Postraumático , Telemedicina , Adolescente , Negro o Afroamericano , Humanos , Instituciones Académicas , Trastornos por Estrés Postraumático/terapia , Tecnología
13.
Am Psychol ; 75(8): 1158-1174, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33252952

RESUMEN

Clinical psychological science has developed many efficacious treatments for diverse emotional and behavioral difficulties encountered by children and adolescents, although randomized trials investigating these treatments have disproportionally been conducted by American, university-based research labs. The subsection of the world population involved in these studies, however, represents very few people among those in need of psychological services whose voices, perspectives, and orientations to therapy have not generally been reflected in well-funded research trials. Dissemination and implementation of evidence-based services designed to meet the needs of this broader global population, therefore, may require cultural and contextual adaptation to be successful. The current article describes the implementation of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in 3 separate low-resourced settings (rural South Carolina, Puerto Rico, and El Salvador) utilizing the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework and guided by a community-based participatory research framework. Emphasis is placed on description of program development, building collaborative and responsive partnerships, and the use of implementation strategies to guide continuous quality improvement. Program evaluation data comparing baseline to posttreatment trauma symptoms and treatment completion rates for all sites are also presented, which suggests that treatment was associated with a large reduction in symptoms, exceeding that noted in many TF-CBT randomized trials. The implications of attention to context, adaptation, and methods of building partnerships with global communities are discussed, with a particular focus on propelling more refined models and controlled studies in the future. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Terapia Cognitivo-Conductual , Investigación Participativa Basada en la Comunidad , Ciencia de la Implementación , Trauma Psicológico/terapia , Adolescente , Niño , Humanos , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Resultado del Tratamiento
14.
JAMA Netw Open ; 2(4): e192619, 2019 04 05.
Artículo en Inglés | MEDLINE | ID: mdl-31026024

RESUMEN

Importance: Quantifying the magnitude of disaster exposure and trauma-related symptoms among youths is critical for deployment of psychological services in underresourced settings. Hurricane Maria made landfall in Puerto Rico on September 20, 2017, resulting in massive destruction and unprecedented mortality. Objective: To determine the magnitude of disaster exposure and mental health outcomes among Puerto Rican youths after Hurricane Maria. Design, Setting, and Participants: Survey study in which a school-based survey was administered to each public school student at all schools in Puerto Rico between February 1 and June 29, 2018 (5-9 months after Hurricane Maria). Of the 226 808 students eligible to participate, 96 108 students completed the survey. Main Outcomes and Measures: Participants were assessed for exposure to hurricane-related stressors, posttraumatic stress disorder (PTSD), and depressive symptoms, using standardized self-report measures administered in Spanish. Descriptive statistics were compiled for all outcome variables, as was the frequency of individuals reporting clinically elevated symptoms of PTSD or depression. Differences in these statistics across sexes were also examined via t tests. Correlations between demographic, geographic, and main outcome variables were also calculated, and regressions were conducted to examine their association with symptoms of PTSD. Results: A total of 96 108 students participated in the study (42.4% response rate; 50.3% female), representative of grades 3 to 12 across all 7 educational regions of Puerto Rico. As a result of the hurricane, 83.9% of youths saw houses damaged, 57.8% had a friend or family member leave the island, 45.7% reported damage to their own homes, 32.3% experienced shortages of food or water, 29.9% perceived their lives to be at risk, and 16.7% still had no electricity 5 to 9 months after the hurricane. Overall, 7.2% of youths (n = 6900) reported clinically significant symptoms of PTSD; comparison of the frequency of reporting clinically elevated symptoms of PTSD across sex yielded a significant difference (t = 12.77; 95% CI of the difference, 0.018-0.025; P < .001), with girls (8.2%) exceeding the clinical cutoff score more often than boys (6.1%). Finally, similar analysis of differences in depression between sexes was also significant (t = 17.56; 95% CI of the difference, 0.31-0.39; P < .001), with girls displaying higher mean (SD) scores (2.72 [3.14]) than boys (2.37 [2.93]). Demographic and risk variables accounted for approximately 20% of variance in symptoms of PTSD (r2 = 0.195; 95% CI, 0.190-0.200). Conclusions and Relevance: Survey results indicate that Hurricane Maria exposed Puerto Rican youths to high levels of disaster-related stressors, and youths reported high levels of PTSD and depressive symptoms. Results are currently being used by the Puerto Rico Department of Education to inform targeted and sustainable evidence-based practices aimed at improving mental health outcomes for Puerto Rico's youths.


Asunto(s)
Tormentas Ciclónicas , Depresión/epidemiología , Desastres , Trastornos por Estrés Postraumático/epidemiología , Estudiantes/psicología , Adolescente , Niño , Depresión/psicología , Femenino , Hispánicos o Latinos/psicología , Humanos , Masculino , Puerto Rico/epidemiología , Factores de Riesgo , Trastornos por Estrés Postraumático/psicología , Encuestas y Cuestionarios
15.
Adm Policy Ment Health ; 45(4): 575-586, 2018 07.
Artículo en Inglés | MEDLINE | ID: mdl-29305776

RESUMEN

This mixed-methods study assessed providers' views of the use of technology in the delivery of an empirically supported mental health treatment for adolescents (Trauma-Focused Cognitive Behavioral Therapy; TF-CBT). Thematic qualitative interviews were conducted with nine experienced providers. Emerging themes served as the basis for the creation of a quantitative web-based survey, completed by 56 TF-CBT experts, to assess the perceived helpfulness of the recommendations. Technology was perceived as a useful, appealing, and familiar tool that could greatly enhance the delivery of this treatment modality with adolescents. Main recommendations included the creation of a mobile application targeting all of the treatment components and a website with developmentally appropriate resources for providers, caregivers, and teens. Technology may be a useful tool for enhancing service delivery and promoting engagement among youth receiving trauma-focused mental health treatment.


Asunto(s)
Actitud del Personal de Salud , Terapia Cognitivo-Conductual/métodos , Atención a la Salud/métodos , Trastorno Depresivo/terapia , Internet , Trastornos por Estrés Postraumático/terapia , Estrés Psicológico/terapia , Telemedicina , Adolescente , Adulto , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles , Trauma Psicológico/psicología , Trauma Psicológico/terapia , Psicología , Investigación Cualitativa , Trabajadores Sociales , Trastornos por Estrés Postraumático/psicología , Estrés Psicológico/psicología , Terapia Asistida por Computador
16.
Child Maltreat ; 22(4): 324-333, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-28868894

RESUMEN

Significant barriers exist in access to evidence-based, trauma-focused treatment among youth from economically disadvantaged backgrounds, those living in rural areas, and belonging to a racial and ethnic minority group, despite the high prevalence rates of trauma exposure among these underserved groups. The present study is proof-of-concept pilot of trauma-focused cognitive-behavioral therapy (TF-CBT) delivered to underserved trauma-exposed youth ( N = 15) via telehealth technology (i.e., via one-on-one videoconferencing), aimed at addressing barriers in access to TF treatment. This pilot study provides preliminary evidence of the ability to successfully deliver TF-CBT via a telehealth delivery format. Results demonstrated clinically meaningful symptom change posttreatment (large effect sizes for youth-reported ( d = 2.93) and caregiver-reported ( d = 1.38) reduction in posttraumatic stress disorder symptoms), with no treatment attrition (0% dropout). These findings are promising in showing treatment effects that are comparable with TF-CBT delivered in an in-person, office-based setting and an important first step in determining how to best address the mental health needs of trauma-exposed youth with barriers in access to care.


Asunto(s)
Síndrome del Niño Maltratado/terapia , Terapia Cognitivo-Conductual/métodos , Telemedicina/métodos , Adolescente , Síndrome del Niño Maltratado/psicología , Niño , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Proyectos Piloto
18.
J Reprod Infant Psychol ; 34(1): 35-48, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27840544

RESUMEN

BACKGROUND/OBJECTIVE: Within the first months of childbirth, clinically significant depressive symptoms are experienced by 19% of mothers in the US, and are even more prevalent among low-income and ethnic-minority women. Paradoxically, low-income and ethnic-minority mothers are faced with unique barriers that make them less likely to receive professional mental health care. To find ways to remove these barriers, a recent US trial extended use of a United Kingdom intervention, Listening Visits (LV), an evidence-based treatment delivered by home visitors/office nursing staff. METHODS: A qualitative content analysis was conducted with participants' (N=19 in an open trial and N=49 in a randomized controlled trial) responses to a post-treatment semi-structured interview assessing their views of LV. The percentage of participants endorsing each thematic code is presented. RESULTS: When the provider first introduced the LV intervention, 77.9% of women retrospectively reported having positive views of trying this new approach. Recipients most frequently mentioned as helpful two aspects of LV: empathic listening/support and the collaborative style of the LV provider. Half of the women (50%) did not suggest changes to how LV were delivered. Among those who suggested changes, the most frequent (42.6%) suggestion was to increase the number/duration of sessions. CONCLUSION: Listening Visits is an acceptable depression treatment approach, as perceived by low-income, ethnic-minority mothers, which health and social service providers who serve this population can use.


Asunto(s)
Depresión Posparto/prevención & control , Madres/psicología , Sistemas de Atención de Punto , Psicoterapia/métodos , Adolescente , Adulto , Etnicidad , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Grupos Minoritarios , Pobreza , Resultado del Tratamiento , Adulto Joven
19.
Clin Nurs Res ; 25(3): 273-90, 2016 06.
Artículo en Inglés | MEDLINE | ID: mdl-26137943

RESUMEN

The purpose of this article was to evaluate attitudes of mothers of newborns hospitalized on the neonatal intensive care unit (NICU) toward nurse-delivered depression screening and counseling. NICU mothers (N = 200) completed questionnaires assessing their views toward being screened for depression by nurses, treatment provider preference, and interest in learning about Listening Visits (LV), a nurse-delivered intervention. The views of 23 LV recipients were also assessed. Most mothers were receptive to depression screening by nurses, two thirds would see a nurse for counseling, and half were interested in learning more about LV. Among LV recipients, half readily embraced the idea and the remaining recipients were skeptical but opted to try. After receiving LV, recipients unanimously rated LV and the skill of the LV provider highly. Screening and counseling by NICU nurses could increase detection of depression and treatment use among at-risk women. Assessing nurses' perspectives about implementing this model of care is an important future research direction.


Asunto(s)
Depresión/psicología , Tamizaje Masivo , Madres/psicología , Rol de la Enfermera/psicología , Adulto , Escalas de Valoración Psiquiátrica Breve , Consejo/métodos , Femenino , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Enfermería Neonatal , Encuestas y Cuestionarios
20.
Rev Puertorriquena Psicol ; 23(2): 48-61, 2012 Jul.
Artículo en Español | MEDLINE | ID: mdl-24575164

RESUMEN

Sexual stereotypes are beliefs that are generally accepted and are thought to define how men and women should express their sexuality. The objectives of this study were to identify how many heterosexual Puerto Rican men and women endorsed certain stereotypes about male and female sexuality and to explore the relationship between the endorsement of these sexual stereotypes and the attitudes towards condom use, as well as actual condom use during intercourse. We conducted a cross-sectional study in which we administered two scales, one about male sexuality and the other about female sexuality, to a group of 429 heterosexual participants. We found that men endorsed significantly more male and female sexual stereotypes than women and that these tended to have a more conservative view of female sexuality than what they had of male sexuality. Women, on the other hand, tended to view female and male sexuality in a less stereotypical way. We also found that the more men and women endorsed male and female sexual stereotypes, the worse the attitudes toward condom use. However, endorsement of male and/or female sexual stereotypes was not related to condom use. These findings contradict the literature that suggests that these sexual stereotypes result in high-risk sexual conduct, which has important implications for the development and implementation of prevention programs.

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