Impact of Race on the Relationship Between Adverse Childhood Experience and Mental Health in the Minnesota Homeless Population

It is well established that the homeless population endorses more adverse childhood experiences (ACEs) than the general population and is also more susceptible to mental health and substance use disorders. Of note, individuals who identify as Black, Indigenous, and People of Color (BIPOC) are disproportionally affected by homelessness compared to their White counterparts. Little is known about the relationships between ACEs, mental health, and substance use in the homeless community. The present study examined the relationship between ACEs and a number of psychosocial outcomes, including mental health diagnoses, current substance use, and long-term substance use in an adult homeless population (N = 412) located in Minnesota. The impact of participant race and ethnicity as a moderator on the relationship between ACEs and various psychosocial outcomes was also explored. The study utilized archival data from the Minnesota Homeless Study (Wilder Research, 2018), which focuses on capturing the experience of the homeless population in Minnesota. Results showed that as the number of ACEs increased among the sample, so did the likelihood of a mental health disorder. Additionally, the number of ACEs reported was significantly associated with long-term substance use, indicating that as the number of ACEs increased, so did the likelihood of long-term substance use. ACEs were not associated with current substance. However, when the homeless population was considered as a whole. When separated by racial/ethnic identity, only White participants were more likely to endorse current substance use as ACEs increased. Directions for future research (short versus long-term substance use) and clinical implications, such as ACE-specific interventions, are discussed

Can families help veterans get more from PTSD treatment? A randomized clinical trial examining Prolonged Exposure with and without family involvement

Abstract Background Posttraumatic stress disorder occurs in as many as one in five combat veterans and is associated with a host of negative, long-term consequences to the individual, their families, and society at large. Trauma-focused treatments, such as Prolonged Exposure, result in clinically significant symptom relief for many. Adherence to these treatments (i.e., session attendance and homework compliance) is vital to ensuring recovery but can be challenging for patients. Engaging families in veterans’ treatment could prove to be an effective strategy for promoting treatment adherence while also addressing long-standing calls for better family inclusion in treatment for posttraumatic stress disorder. This paper describes the methods of a pragmatic randomized controlled trial designed to evaluate if family inclusion in Prolonged Exposure can improve treatment adherence. Methods One hundred fifty-six veterans, with clinically significant symptoms of posttraumatic stress disorder, will be randomized to receive either standard Prolonged Exposure or Prolonged Exposure enhanced through family inclusion (Family-Supported Prolonged Exposure) across three different VA facilities. Our primary outcomes are session attendance and homework compliance. Secondary outcomes include posttraumatic stress disorder symptom severity, depression, quality of life, and relationship functioning. The study includes a concurrent process evaluation to identify potential implementation facilitators and barriers to family involvement in Prolonged Exposure within VA. Discussion While the importance of family involvement in posttraumatic stress disorder treatment is non-controversial, there is no evidence base supporting best practices on how to integrate families into PE or any other individually focused trauma-focused treatments for posttraumatic stress disorder. This study is an important step in addressing this gap, contributing to the literature for both retention and family involvement in trauma-focused treatments. Trial registration ClinicalTrials.gov NCT03256227 . Registered on August 21, 2017.http://deepblue.lib.umich.edu/bitstream/2027.42/173826/1/13063_2022_Article_6183.pd