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Wang L, Norman I, Edleston V, Oyo C, Leamy M. The Effectiveness and Implementation of Psychological First Aid as a Therapeutic Intervention After Trauma: An Integrative Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380231221492. [PMID: 38281196 DOI: 10.1177/15248380231221492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Psychological First Aid (PFA) is known to be an initial early intervention following traumatic exposure, yet little is known about its optimal implementation and effectiveness. This review aims to examine the evidence for the effectiveness of PFA interventions and how PFA interventions have been designed, implemented, and experienced. MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsychINFO, Embase, Web of Science, PILOTS, and China National Knowledge Infrastructure (in Chinese) databases were searched. Twenty studies from 4,735 records were included and quality rated, followed by an integrative synthesis of quantitative and qualitative evidence. PFA intervention following trauma exposure shows a positive effect for reducing anxiety and facilitating adaptive functioning in the immediate and intermediate term, yet the evidence for reducing Post-traumatic stress disorder/depressive symptoms is less compelling. Furthermore, commonalities in the components and techniques across different PFA approaches identified tend to align with four of Hobfoll's five essential elements: safety, calm, efficacy, and connectedness (as reflected among 7/11 PFA protocols), whereas the "hope" element was less developed. These commonalities include active listening, relaxation/stabilization, problem-solving/practical assistance, and social connection/referral. Intensive techniques such as cognitive reconstruction have also been incorporated, intensifying PFA delivery. The substantial variation observed in PFA format, timing, and duration, coupled with inadequate documentation of fidelity of implementation and adaptation, further constrains the ability to inform best practices for PFA. This is concerning for lay frontline providers, vital in early trauma response, who report implementation challenges despite valuing PFA as a time-sensitive, supportive, and practical approach.
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Ash MJ, Knutzen KE, Ogbeide I, Renfro TL, Ramirez MR, Woods-Jaeger B. Barriers and Facilitators to the Online Delivery of a School-Based Intervention to Reduce Racial Trauma. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:750-762. [PMID: 37332082 DOI: 10.1007/s10488-023-01281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/20/2023]
Abstract
Students of color face disproportionate rates of adverse childhood experiences, including racial discrimination in school settings. Effective interventions strategies are needed to address school-based racial trauma. Link for Equity was designed to be a culturally-responsive trauma-informed intervention that includes universal cultural humility training for teachers. As a result of the COVID-19 pandemic, the in-person trauma-informed cultural humility training was adapted for online delivery. The purpose of this study was to assess barriers and facilitators that impacted online delivery of the training. We conducted semi-structured interviews with 25 high school teachers from three public school districts in the Midwestern United States who participated in the online training. Interview transcripts were coded by two team members, and thematic analysis was utilized. Barriers and facilitators to online delivery were identified across five domains: receptivity, logistics, engagement, comfort, and application. The implications of these barriers and facilitators are discussed and tailored recommendations for the virtual delivery of culturally-responsive trauma-informed interventions to reduce racial discrimination in schools are provided.
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Affiliation(s)
- Marcia J Ash
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA.
| | - Kristin E Knutzen
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Ighedosa Ogbeide
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Tiffaney L Renfro
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - Marizen R Ramirez
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Briana Woods-Jaeger
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
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Ramirez MR, Ryan A, Harding AB, Renfro T, Church TR, Rosebush C, Trotter AG, Xiong BN, Gonzalez J, Woods-Jaeger B. Link for Equity, a community-engaged waitlist randomized controlled trial of a culturally responsive trauma-informed care program for BIPOC students: Design features and characteristics of baseline sample. Contemp Clin Trials 2023; 126:107090. [PMID: 36681238 DOI: 10.1016/j.cct.2023.107090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 12/30/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Link for Equity is a multi-tiered, school-based program of trauma-informed care and cultural humility designed to reduce the impact of Adverse Child Experiences among Black Indigenous and other children of color (BIPOC). This report describes the program, its trial design, and the study participants' baseline characteristics. METHODS We designed a nested waitlist-controlled trial to evaluate Link for Equity's effectiveness in reducing school violence among BIPOC students. Three pairs of school districts, matched on suspension rates and enrollment of Black/African American, Hispanic/Latinx, and American Indian/Alaska Native children, were randomized into either an intervention or delayed intervention (waitlist control) group. A community-engaged approach guided the development of protocols. Within intervention sites, BIPOC students who screened positive for ACEs or posttraumatic stress were also randomized into an immediate and waitlist control group to receive additional one-on-one support from trained school staff. RESULTS The trial was implemented from 2019 to 2021, which overlapped with the pandemic and civil unrest in Minnesota. At baseline, 444 staff and 188 students enrolled in the study. Over a quarter of American Indian/Alaska Native students, 18% of multiple race, 12% of Black/African American, 14% of Hispanic/Latinx students reported 4+ ACEs. Between 44 and 53% of all the BIPOC students in the study were symptomatic for PTSD. Of the enrolled students, 78.7% qualified for one-on-one Link support. CONCLUSION We implemented a multilevel waitlist-controlled trial of Link for Equity using community-engaged methods. Despite school closures during the pandemic, the study persisted with its methods now being employed in an expanded cohort of middle schools. TRIAL REGISTRATION ClinicalTrials.gov (NCT04026477, NCT04026490).
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Affiliation(s)
- Marizen R Ramirez
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Andrew Ryan
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alyson B Harding
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Tiffaney Renfro
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Timothy R Church
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Christina Rosebush
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alexis Grimes Trotter
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Bao Nhia Xiong
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - John Gonzalez
- Department of Psychology, Bemidji State University, Bemidji, MN, USA
| | - Briana Woods-Jaeger
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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