Mental health symptoms and engagement in a stepped-care mental health service among patients with a violent versus nonviolent injury

BACKGROUND

Few studies have examined mental health symptom trajectories and engagement in mental health follow-up in relation to mechanism of injury. This study examined differences in engagement between survivors of nonviolent and violent injury in the Trauma Resilience and Recovery Program (TRRP), a stepped-care, technology-enhanced model that provides evidence-based mental health screening and treatment to patients admitted to our Level I trauma service.

METHODS

This study analyzed data from 2,527 adults enrolled in TRRP at hospital bedside between 2018 and 2022, including 398 patients (16%) with a violent injury and 2,129 patients (84%) with a nonviolent injury. Bivariate and hierarchical logistic regression analyses examined relations between injury type (violent vs. nonviolent) engagement in TRRP and mental health symptoms at 30 day follow-up.

RESULTS

Engagement in services at bedside was similar across survivors of violent and nonviolent traumatic injury. Patients with violent injury had higher levels of posttraumatic stress disorder and depressive symptoms 30 days postinjury but were less likely to engage in mental health screening. Among patients who screened positive for posttraumatic stress disorder and depression, patients with violent injury were more likely to accept treatment referrals.

CONCLUSION

Patients with a violent traumatic injury have higher levels of mental health needs yet face greater barriers to accessing mental health services following their injury relative to those with a nonviolent injury. Effective strategies are needed to ensure continuity of care and access to mental health care to promote resilience and emotional and functional recovery.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.

A Comparison of the Readiness of Youth Service Agencies to Implement a Technology-Based Toolkit to Support Treatment Delivery

Implementation initiatives and technology-based resources aim to address barriers to Evidence-Based Practice (EBP) use by creating generalizable techniques that can be used for a variety of youth-serving agencies. However, research has not carefully examined unique differences between agency types or individual programs in readiness to use such technologies and implementation strategies. The current study explored differences between community mental health clinics and child advocacy centers on organizational cultural factors (e.g., ability to change and commitment for change) to implement a novel technology-based toolkit to support delivery of Trauma Focused Cognitive Behavioral Therapy (TF-CBT). Results indicated that TF-CBT providers from child advocacy centers reported greater commitment to change and more support to use the technology-based system than those from community mental health centers. Findings suggest that implementation initiatives should address the needs of individual agencies and service settings and adaptations should be explored to best meet the needs of these settings.

Addressing a Mental Health Intervention Gap in Juvenile Detention: A Pilot Study

Research suggests that 60-70% of adolescents detained in the juvenile justice system meet criteria for a mental health disorder compared to 20% of the general adolescent population; however, the vast majority do not receive services. Unfortunately, mental health symptoms often worsen during detainment, and detainment is linked to lower levels of educational attainment and increased risk of adult recidivism. Thus, not only are these adolescents unlikely to receive needed mental health care, but also the lack of interventions in detention may exacerbate inequities of contact with the criminal justice system in adulthood. In addition to these youth being an underserved population broadly, youth of color are also disproportionately incarcerated compared to their white counterparts. The current paper describes results of a pilot study of an Acceptance and Commitment Therapy (ACT)-based behavioral skills intervention, aimed at providing evidence-based mental health treatment for an adolescent population at risk of long-term adverse mental health outcomes. The study included 128 males aged 14-17 who resided in juvenile detention. Results demonstrated that the intervention was acceptable to participants, feasible to provide in detention, and could be implemented with fidelity and competency. Intervention participants demonstrated declines in symptoms of mental health, and ACT-specific constructs of experiential avoidance, cognitive fusion, and perceived barriers to moving toward their values. These results have important implications for the possibility of an effective intervention that could disrupt systemic inequity in youth mental health, and thus support further testing of this intervention in a randomized controlled trial.

Understanding the perception of stakeholders in reducing adolescent-to-parent violence/aggression

INTRODUCTION

Adolescent-to-parent violence/aggression (APV/A) is an understudied yet increasingly common social problem for adolescents and families, particularly those involved in the juvenile justice system. The current study focused on improving interventions for this population by gathering qualitative data from stakeholders to inform treatment targets.

METHODS

Participants (N = 23) comprised of court professionals (n = 7), parents/guardians (n = 9), and their male adolescent children (n = 7) in the United States. Parent and adolescent participants were recruited through monthly court-mandated domestic violence education classes offered by the juvenile court. Parent/guardian participants were between the ages of 38 and 77 and consisted of four males and five females. Adolescents were between the ages of 14 and 17. Court professional participants consisted of judges, probation officers, and court psychologists. Semi-structured interviews were analyzed qualitatively using grounded theory.

RESULTS

Results indicated that, from the perspective of key stakeholders, an effective intervention to reduce APV/A likely involves a two-pronged approach: (1) address specific and theoretically modifiable emotional, behavioral, and psychological factors at the adolescent-level; and (2) induce change in the family system by addressing environmental barriers to seeking treatment and by creating positive family relationships.

CONCLUSIONS

The present study aimed to gather the perspectives of court professionals, adolescents, and parents/guardians regarding the development of an effective intervention for APV/A-involved families. This study represents the first step toward the development of a feasible, acceptable, sustainable, and effective intervention for adolescents and their families who are involved in the juvenile justice system due to APV/A.

Multidisciplinary partnership: Targeting aggression and mental health problems of adolescents in detention

Justice-involved adolescents meet diagnostic criteria for mental health disorders at much higher rates than their counterparts, and this increased risk persists into young adulthood (Abram et al., 2015; Teplin, Abram, McClelland, Dulcan, & Mericle, 2002). Despite growing recognition of this problem, there remains a dearth of adequate therapeutic services in juvenile detention and marked variation in the quality and availability of community-based services (Kretschmar, Butcher, Flannery, & Singer, 2016). This article presents the development of a multidisciplinary partnership among clinical research psychologists and court professionals to address aggressive behaviors and unmet mental health needs of adolescents in the juvenile justice system. We describe the early stages of collaboration, in which experts from disparate disciplines joined forces to address a mounting problem in the juvenile justice system that represented both a gap in the research-practice continuum and a lack of vital mental health resources in the local community. We delineate the team composition, outline key players' roles and contributions, and describe the principles that guided our collaboration across disciplines and agencies. We were effective in developing a sustainable multidisciplinary team, developing a new intervention, and implementing this new intervention in a challenging setting. The challenges we encountered throughout the process as well as the solutions that were generated and the lessons learned are discussed in detail. We discuss the substantive outcomes of our research and conclude with recommendations for readers interested in organizing similar academic-research/community partnerships. (PsycINFO Database Record (c) 2019 APA, all rights reserved).