Children's mental health care following Hurricane Katrina: A field trial of trauma‐focused psychotherapies

Jaycox, Lisa H.; Cohen, Judith A.; Mannarino, Anthony P.; Walker, Douglas W.; Langley, Audra K.; Gegenheimer, Kate L.; Scott, Molly M.; Schonlau, Matthias

doi:10.1002/jts.20518

Cited by 224 publications

(241 citation statements)

References 31 publications

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“…While it is clear that school-based services can dramatically increase the number of children who receive needed mental healthcare, 27 improving child mental health also depends on effective implementation of programs. 37 Despite the plethora of effective evidence-based interventions for various childhood disorders (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Despite major efforts to engage families and overcome logistical obstacles, only 12% of those assigned to TF-CBT completed treatment, compared to 93% of those assigned to CBITS. 27 Clearly, quality school-based programs have the potential to reduce barriers to accessing services and impact many students in need of intervention.School-based services may be particularly important for underserved ethnic minority youth who traditionally are less likely to receive such services, despite increased risk for violence exposure and mental health problems due to risk factors including poverty [28][29][30] …”

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confidence: 99%

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Improving Implementation of Mental Health Services for Trauma in Multicultural Elementary Schools: Stakeholder Perspectives on Parent and Educator Engagement

Langley¹,

Rodríguez²,

Santiago³

2012

PsycEXTRA Dataset

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Although more schools are offering mental health programs, few studies have involved the school community in research to improve their successful implementation. In this community partnered study, focus groups were conducted with school staff and parents to explore issues related to community engagement and feasibility of a mental health intervention for elementary school students exposed to trauma. Four educator focus groups, including 23 participants, and 2 parent focus groups, consisting of 9 Spanish-speaking and 7 English-speaking parents were conducted. Participants discussed facilitators and barriers to successful implementation of the program. Participants identified the importance of pre-implementation parent education, raising awareness of the impact of student mental health among educators, maintaining ongoing communication during the intervention, and addressing logistical concerns. Participants described clear considerations for parent and educator engagement both at the pre implementation phase and during implementation of the program. Implications for next steps of this community partnered approach are described. Exposure to traumatic events and interpersonal violence is a growing concern, 1-3 with estimates that 20 to 50% of American children are victims of trauma within their families, at school, and in their communities. 4 Recent studies suggest that 40% of 8-11 year old elementary school children reported having their life threatened 5 and 68% of adolescents have experienced at least one potentially traumatic experience in their lifetime 6 ranging from physical abuse, sexual abuse, and exposure to domestic or community violence. Moreover, children in vulnerable populations such as low-income urban youth and immigrant children have often been exposed to multiple traumatic events and secondary adversities. [7][8][9] Studies have documented the broad range of negative sequelae of trauma exposure for children, including posttraumatic stress disorder (PTSD; 10-11 anxiety; 12-13 and depression 10,14 ). Further, trauma exposure is related to impairment in school functioning and more school absences; 15-16 decreased rates of high school graduation; 17 and aggressive and delinquent behavior. 18 Although not every child exposed to a traumatic event goes on to develop a psychological problem, there is little doubt that these experiences are harmful for many children. Schools, Access, and Mental Health DisparitiesDespite effective cognitive-behavioral interventions, many children are left untreated. Currently, only about 20% of children in need of mental health services are accessing these services. [23][24] Consistent with the Surgeon General's National Action Agenda for child mental health services, it is crucial to bring more evidence-based treatments into naturalistic settings such as schools to reduce mental health disparities and increase access to services. 25 Of those children currently accessing mental health services, three-fourths of them receive care through the education sector. 26 In...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Improving Implementation of Mental Health Services for Trauma in Multicultural Elementary Schools: Stakeholder Perspectives on Parent and Educator Engagement

Langley¹,

Rodríguez²,

Santiago³

2012

PsycEXTRA Dataset

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“…However, other youth trauma interventions have shown decreased rates of attrition as well as increased initial intervention uptake (i.e., rate of initiating treatment after randomization). For instance, Jaycox et al (2010) report a substantially higher rate of uptake (98%) and a lower rate of attrition (9%) for children randomized to receive trauma-focused intervention in schools following Hurricane Katrina.…”

Section: Methods Participantsmentioning

confidence: 99%

Internalizing and Externalizing Symptoms Moderate Treatment Response to School-Based Trauma and Grief Component Therapy for Adolescents

Herres

Williamson

Kobak

et al. 2016

School Mental Health

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Internalizing and externalizing problems commonly co-occur with adolescent post-traumatic stress and grief reactions. However, little is known about whether these co-occurring symptoms moderate adolescents' response to sequenced components of trauma-and grieffocused interventions. Forty-four middle school students (aged 12-14) rated their self-identified Top Problem during a 17-week flexibly tailored course of Trauma and Grief Component Therapy for Adolescents (TGCTA), a groupbased treatment for traumatized and bereaved youth. Baseline internalizing and externalizing symptoms were examined as potential moderators of adolescents' response to skills-building (Module I), narrative-sharing (Modules II and III), and developmental progression (Module IV) phases of intervention. Piecewise analyses of change during the three treatment phases indicated that adolescents with more internalizing symptoms showed significantly less improvement during the skills-building phase and significantly more improvement during the narrative construction phase. Findings provide preliminary evidence that: (a) traumatized and bereaved adolescents show different trajectories of response to different TGCTA components as a function of internalizing versus externalizing baseline symptoms and (b) assessing self-nominated problems and broad-spectrum internalizing and externalizing symptoms can guide trauma-and bereavement-informed treatment planning and monitoring.

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“…An intervention designed specifically for use in schools is CognitiveBehavioral Intervention for Trauma in Schools (CBITS). 61 CBITS, which is founded on cognitive-behavioral therapy, provides mental health screening and brief therapy sessions to help youth reduce trauma-related symptoms and promote coping skills. CBITS is delivered through 10 weekly group sessions led by a school-based mental health professional, such as a school psychologist or social worker, with groups of 6 to 8 participating youth.…”

Section: Evidence-based Interventionsmentioning

confidence: 99%

Adverse Childhood Experiences and Resilience: Addressing the Unique Needs of Adolescents

Soleimanpour

Geierstanger

Brindis

2017

Academic Pediatrics

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Adolescents exposed to adverse childhood experiences (ACEs) have unique developmental needs that must be addressed by the health, education, and social welfare systems that serve them. Nationwide, over half of adolescents have reportedly been exposed to ACEs. This exposure can have detrimental effects, including increased risk for learning and behavioral issues and suicidal ideation. In response, clinical and community systems need to carefully plan and coordinate services to support adolescents who have been exposed to ACEs, with a particular focus on special populations. We discuss how adolescents' needs can be met, including considering confidentiality concerns and emerging independence; tailoring and testing screening tools for specific use with adolescents; identifying effective multipronged and cross-system trauma-informed interventions; and advocating for improved policies.KEYWORDS: adolescent health policy; adolescents; adverse childhood experiences; resilience; trauma ACADEMIC PEDIATRICS 2017;17:S108-S114 ADVERSE CHILDHOOD EXPERIENCES (ACEs) are increasingly a focus of both research and interventions nationwide, given emerging evidence of their high prevalence and lifelong health impacts. To date, much of the ACEs literature has focused on children and adults. Greater attention should be paid to the distinct developmental needs of adolescents and how the systems that serve them can more adequately respond.Distinct from both childhood and adulthood, adolescence is a unique developmental stage of rapid growth during which physiologic, cognitive, social, and emotional changes occur simultaneously. During this time (ages 11 to 21 years), adolescents experience physical and sexual maturation, develop more abstract and long-term thinking, and engage in risk-taking behaviors as they establish their independence. Adolescents who have experienced ACEs may be less able to successfully navigate this transformational stage as a result of the damaging effects of traumatic experiences on their emotional and cognitive development and/or lack of or limited positive supports.A large body of research has demonstrated that investments in early childhood can yield significant social and economic returns in adulthood and that this developmental stage should be prioritized for investments, particularly for disadvantaged youth. 1,2 However, this research also supports the notion that to maximize returns, there is a concurrent need to invest resources to address the needs of adolescents, particularly for those who may not have received needed supports in early childhood and/or who continue to experience ACEs into adolescence.Thus, adolescence represents a key window of opportunity to ameliorate the short-and longer-term impacts of trauma and positively alter the life course trajectory. High rates of trauma exposure have led to a pressing need to identify youth who have been exposed; recognize the varied ways in which youth respond to these experiences; identify effective strategies to provide traumainformed care; and d...

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Children's mental health care following Hurricane Katrina: A field trial of trauma‐focused psychotherapies

Cited by 224 publications

References 31 publications

Improving Implementation of Mental Health Services for Trauma in Multicultural Elementary Schools: Stakeholder Perspectives on Parent and Educator Engagement

Improving Implementation of Mental Health Services for Trauma in Multicultural Elementary Schools: Stakeholder Perspectives on Parent and Educator Engagement

Internalizing and Externalizing Symptoms Moderate Treatment Response to School-Based Trauma and Grief Component Therapy for Adolescents

Adverse Childhood Experiences and Resilience: Addressing the Unique Needs of Adolescents

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