School-based racial microaggressions: A barrier to resilience among African American adolescents exposed to trauma.

OBJECTIVE: African American adolescents experience disproportionate rates of adverse childhood experiences (ACEs), which heightens their risk for negative social, behavioral, and health outcomes. Schools may be a source of support for adolescents exposed to ACEs; however, for many African American adolescents, schools are a source of additional stress due to experiences of racial/ethnic microaggressions. The current study examined the relationship between ACEs, school-based racial/ethnic microaggressions, and resilience after violence exposure in African American adolescents. METHOD: Participants included 189 African American adolescents with an average age of 15.15 (SD = 1.27, range = 13-18). Fifty-one percent identified as female. Participants reported an average ACE score of 5.81 (SD = 3.63). Moderation analyses were conducted using the three subscales of the School-based Racial and Ethnic Microaggression Scale (academic inferiority, expectations of aggression, and stereotypical misrepresentations; Keels et al., 2017). RESULTS: ACEs were negatively related to resilience after violence exposure in all three microaggression models. The microaggressions subscales academic inferiority (b = -.05, t(183) = -2.05, p = .04) and stereotypical misrepresentations (b = -.08, t(183) = -2.04, p = .04) significantly moderated the relationship between ACEs and resilience after violence exposure, such that the inverse relationship between these two variables was stronger at higher levels of endorsed microaggressive experiences measured with these two subscales. The moderation model was not significant for the expectations of aggression subscale. CONCLUSIONS: Findings suggest that school-based racial/ethnic microaggressions negatively impact resilience after violence exposure among African American adolescents exposed to multiple ACEs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Engaging parent-child dyad and healthcare provider stakeholders in a patient-centered comparative effectiveness study.

Aim: Describe engagement activities in a comparative effectiveness study evaluating two interventions for promoting psychosocial health among youth ages 10-17 who have recently experienced a nonintentional injury. Methods: Institutional, community and patient stakeholders from four children's hospitals were engaged through consultation meetings, individual interviews and a collaborative meeting. Results: 67 engagement activities were conducted across four hospitals. Feedback to improve recruitment, retention and continuous engagement in the study was obtained. Finally, disseminating study interventions to school and healthcare settings, and adding alternative delivery formats were identified as priority next steps. Conclusion: Results highlight diverse methods of engaging patient and professional stakeholders, critical recommendations for improving study engagement and retention, and future directions for this patient-engaged comparative effectiveness research.

Promoting Resilience: Breaking the Intergenerational Cycle of Adverse Childhood Experiences.

Adverse childhood experiences (ACEs), including trauma exposure, parent mental health problems, and family dysfunction, put children at risk for disrupted brain development and increased risk for later health problems and mortality. These negative effects may be prevented by resilience promoting environments that include protective caregiving relationships. We sought to understand (1) parents' experiences of ACEs, (2) the perceived impact on parenting, (3) protective factors that buffer ACEs potential negative impact, and (4) supports and services that can reduce the number and severity of ACEs and promote resilience among children exposed to early adversity. We conducted in-depth qualitative interviews with 11 low-income, urban parents of young children who had experienced ACEs. Interviews were analyzed for emergent themes and shared with parents from the community to ensure relevance and proper interpretation. Themes from these interviews describe the potential intergenerational cycle of ACEs and key factors that can break that cycle, including parent aspirations to make children's lives better and parent nurturance and support. Parents' suggestions for intervention are also presented. Our findings illuminate protective factors and family strengths that are important to build upon when developing and implementing interventions to promote resilience among parents and children exposed to early adversity. This study benefits from highly ecologically valid data obtained from low-socioeconomic status, racial/ethnic minority parents through one-on-one in-depth interviews and interpreted with the aid of community stakeholders through a community-based participatory research approach.

Building a Collaboration Between a Children's Hospital and an Early Childhood Education and Social Services Center.

To address toxic stress among children growing up in poverty, an innovative collaboration was developed between a community center, Operation Breakthrough (OB), and a tertiary care children's hospital, Children's Mercy Hospital (CMH). OB started as a day care center but has expanded and developed ways to provide shelter, safety, food, employment, education and health care. CMH is a traditional academic children's hospital that, in recent years, has been looking for ways to better address the social determinants of health. This article describes how the two organizations found ways to work together to capitalize on each other's strengths. Although the two institutions shared some common goals, they had very different organizational structure. We describe how a series of complex negotiations and trust-building exercises eventually led to a robust and unique partnership.

The art and skill of delivering culturally responsive trauma-focused cognitive behavioral therapy in Tanzania and Kenya.

OBJECTIVE: This study explored the facilitators, barriers, and strategies used to deliver a child mental health evidence-based treatment (EBT), trauma-focused cognitive behavioral therapy (TF-CBT), in a culturally responsive manner. In low- and middle-income countries most individuals with mental health problems do not receive treatment due to a shortage of mental health professionals. One approach to addressing this problem is task-sharing, in which lay counselors are trained to deliver mental health treatment. Combining this approach with a focus on EBT provides a strategy for bridging the mental health treatment gap. However, little is known about how western-developed EBTs are delivered in a culturally responsive manner. METHOD: Semistructured qualitative interviews were conducted with 12 TF-CBT lay counselors involved in a large randomized controlled trial of TF-CBT in Kenya and Tanzania. An inductive approach was used to analyze the data. RESULTS: Lay counselors described the importance of being responsive to TF-CBT participants' customs, beliefs, and socioeconomic conditions and highlighted the value of TF-CBT for their community. They also discussed the importance of partnering with other organizations to address unmet socioeconomic needs. CONCLUSION: The findings from this study provide support for the acceptability and appropriateness of TF-CBT as a treatment approach for improving child mental health. Having a better understanding of the strategies used by lay counselors to ensure that treatment is relevant to the cultural and socioeconomic context of participants can help to inform the implementation of future EBTs. (PsycINFO Database Record

Engaging African American Faith-Based Organizations in Adolescent HIV Prevention.

To reduce current HIV disparities among African American youth, it is imperative to find effective ways to extend the reach of evidence-based HIV prevention. One promising community resource to support this effort is faith-based organizations (FBOs), a credible and respected resource in the African American community. This paper describes the experiences, perceptions, and challenges that African American FBOs and faith leaders face in engaging in adolescent HIV prevention and highlights facilitators and barriers to implementing HIV prevention in African American FBOs. The findings suggest that African American FBOs and faith-based leaders are uniquely positioned to be instrumental resources in reducing African American youth HIV disparities.

Where is the faith? Using a CBPR approach to propose adaptations to an evidence-based HIV prevention intervention for adolescents in African American faith settings.

African American adolescents are at increased risk for HIV/AIDS. Using a community-based participatory research approach, we engaged three black churches in adapting an evidence-based HIV prevention intervention, Focus on Youth (FOY)+ImPACT, for faith settings. To identify potential adaptations to increase FOY's relevance, utility, and efficacy for faith settings, we conducted eight focus groups pre- and post-intervention. Recommendations for maintaining FOY's core elements and enhancing its cultural authenticity include the following: incorporating faith tools, building pastor capacity, strengthening parent-child communication skills, and expanding social support for parents and youth. Engaging faith communities in adapting and implementing evidence-based HIV prevention programs could reduce HIV/AIDS disparities.

The relationship between substance use and sexual health among African-American female adolescents with a history of seeking mental health services.

BACKGROUND: This study examined relationships between substance use patterns and problems and sexual health outcomes among low-income, urban, African-American female adolescents with a history of seeking mental health services. METHODS: Participants were recruited from outpatient mental health clinics serving urban, primarily low-income youth and families in Chicago, Illinois, as part of a 2-year, longitudinal investigation of HIV risk behavior during which they completed interviews every 6 months (five time points). Girls who completed at least one follow-up interview were invited to participate in a sixth wave of assessment to assess trauma exposure, substance use problems, and sexual risk. The current study (n = 177) examined the association between sexual risk behavior and substance use problems reported at the most recent interview (ages 14-22) and substance use patterns and sexually transmitted infections (STI) reported at all six times points. Multiple regression examined the combined and unique effects of different patterns of substance use and substance use problems as correlates of sexual risk behavior and STIs. FINDINGS: Substance use problems were associated with increased sexual risk behavior and increased likelihood of experiencing STIs. Substance use patterns were associated with sexual risk behavior. CONCLUSIONS: Results suggest that specific patterns of substance use and substance use problems are important to address in sexual health promotion among low-income, urban, African-American girls with a history of seeking mental health services. Understanding the nuances of these relationships is important in informing how to best serve this vulnerable group of adolescents who experience significant sexual risk and mental health care disparities.

Exploring the social and community context of African American adolescents' HIV vulnerability.

There is an increasing call for HIV prevention programs that target social determinants of HIV. The purpose of this study was to examine the experiences and perceptions of 12 African American adolescents to identify important social and community targets for HIV prevention. We used photovoice methodology to engage adolescents in a critical analysis of their experiences to arrive at a deeper understanding of the social determinants of HIV and determine specific action steps to reduce HIV risk. Analyses revealed a variety of social and environmental factors that affect the lives of African American adolescents by creating conditions that put them at greater risk for HIV. Study findings support mobilizing community action through raising awareness and advocating for increased neighborhood resources and institutional support. We conclude with research and practice implications for community-relevant HIV prevention among African American youth.