Post-traumatic stress disorder in children and adolescents exposed to violence

A cluster-randomized trial of a college health center-based alcohol and sexual violence intervention (GIFTSS): Design, rationale, and baseline sample

INTRODUCTION

Sexual violence (SV) on college campuses is common, especially alcohol-related SV. This is a 2-arm cluster randomized controlled trial to test a brief intervention to reduce risk for alcohol-related sexual violence (SV) among students receiving care from college health centers (CHCs). Intervention CHC staff are trained to deliver universal SV education to all students seeking care, to facilitate patient and provider comfort in discussing SV and related abusive experiences (including the role of alcohol). Control sites provide participants with information about drinking responsibly.

METHODS

Across 28 participating campuses (12 randomized to intervention and 16 to control), 2292 students seeking care at CHCs complete surveys prior to their appointment (baseline), immediately after (exit), 4months later (T2) and one year later (T3). The primary outcome is change in recognition of SV and sexual risk. Among those reporting SV exposure at baseline, changes in SV victimization, disclosure, and use of SV services are additional outcomes. Intervention effects will be assessed using generalized linear mixed models that account for clustering of repeated observations both within CHCs and within students.

RESULTS

Slightly more than half of the participating colleges have undergraduate enrollment of ≥3000 students; two-thirds are public and almost half are urban. Among participants there were relatively more Asian (10 v 1%) and Black/African American (13 v 7%) and fewer White (58 v 74%) participants in the intervention compared to control.

CONCLUSIONS

This study will offer the first formal assessment for SV prevention in the CHC setting. Clinical Trials #: NCT02355470.

Poly-Victimization Risk in Prison: The Influence of Individual and Institutional Factors

Victimization research suggests that individuals who either witness or are direct victims of violence are substantially more likely to experience long-term negative outcomes. Although recent studies identifying factors associated with prison victimization are emerging, the risk factors predicting inmate's experience of multiple types of victimization, called poly-victimization, remain unknown. Utilizing a lifestyles model that incorporates the importation/deprivation framework, the current study examines whether certain features of the prison environment or individual characteristics predict who is most likely to experience victimization. Data from more than 1,600 recently released inmates confirm that the environmental and individual-level factors are related to poly-victimization in prison. The findings from the study have implications for policy and practice.

Community violence and youth: affect, behavior, substance use, and academics

Community violence is recognized as a major public health problem (WHO, World Report on Violence and Health, 2002) that Americans increasingly understand has adverse implications beyond inner-cities. However, the majority of research on chronic community violence exposure focuses on ethnic minority, impoverished, and/or crime-ridden communities while treatment and prevention focuses on the perpetrators of the violence, not on the youth who are its direct or indirect victims. School-based treatment and preventive interventions are needed for children at elevated risk for exposure to community violence. In preparation, a longitudinal, community epidemiological study, The Multiple Opportunities to Reach Excellence (MORE) Project, is being fielded to address some of the methodological weaknesses presented in previous studies. This study was designed to better understand the impact of children's chronic exposure to community violence on their emotional, behavioral, substance use, and academic functioning with an overarching goal to identify malleable risk and protective factors which can be targeted in preventive and intervention programs. This paper describes the MORE Project, its conceptual underpinnings, goals, and methodology, as well as implications for treatment and preventive interventions and future research.

Protecting children from the dangers of urban poverty

Exposure to the social ecology of poor urban neighborhoods significantly increases the incidence of traumatic stress disorders, placing children growing up in such neighborhoods at disproportionate risk. Although the risk factors for and effects of childhood complex traumatic stress disorders are well documented, there is little intervention research to guide the delivery of services to this population. This paper builds on current knowledge of childhood trauma and related treatments by introducing an intervention model using constructive family ritual functioning as a mechanism for increasing the protective function of the family. The intervention model postulates that use of family rituals as a coping resource will lead to decreased symptoms of chronic traumatic stress and rates of exposure to additional trauma.

Psychosocial treatment of children in foster care: a review

A substantial number of children in foster care exhibit psychiatric difficulties. Recent epidemiological and historical trends in foster care, clinical findings about the adjustment of children in foster care and adult outcomes are reviewed, followed by a description of current approaches to treatment and extant empirical support. Available interventions for these children can be categorized as either symptom-focused or systemic, with empirical support for specific methods ranging from scant to substantial. Even with treatment, behavioral and emotional problems often persist into adulthood resulting in poor functional outcomes. We suggest that self-regulation may be an important mediating factor in the appearance of emotional and behavioral disturbance in these children.

[Post-traumatic stress syndrome in children]

Post traumatic stress disorder occurs in children as well as in adults following a stressful traumatic event, either unique and exceptionally severe, or recurrent as in abused children. The main symptoms are repetition, avoidance and neurovegetative activation. Prevention and recognition of this disorder are important. Parents must be sensitized to the necessity of an early management.