Master of Science

thesisRecent neurobiological, epidemiological, and psychological research has provided evidence for a dissociative subtype of PTSD. However, much of the current evidence base has only included samples of adults with acute trauma exposure, and the literature has not yet determined if there are systematic differences between individuals who do and do not meet criteria for the dissociative subtype. Therefore, additional research is needed to determine whether the dissociative subtype is valid in youth with chronic trauma exposure and what factors affect the likelihood of dissociative subtype membership in youth. Using a sample of 248 adolescents (90 girls, 158 boys) between the ages of 13 to 19, this study sought to confirm the dissociative subtype of PTSD in a sample of traumatized adolescents and to investigate whether peritraumatic dissociation, emotion dysregulation, gender, and betrayal trauma exposure affected the likelihood of dissociative subtype membership. Results indicated that approximately half of participants (50.8%) met criteria for the dissociative subtype. Furthermore, results of logistic regression indicated that adolescents with greater levels of peritraumatic dissociation and emotion dysregulation were at an increased risk of subtype membership. This study has important implications concerning those adolescents who may be particularly likely to receive the dissociative subtype label

Doctor of Philosophy

dissertationPrevious research has indicated that youth with a history of maltreatment are more likely to evidence offending behaviors and experience formal involvement in the juvenile justice system compared to nonmaltreated youth. In recent years, increased efforts have been made towards identifying the specific characteristics and correlates of youth known to both the child welfare and juvenile justice systems, a population often referred to as "crossover youth." However, despite identifying risk factors associated with the crossover population, there are a number of limitations to the extant literature, many of which stem from the fact that the majority of studies involving crossover youth thus far have been descriptive in nature. This study investigated the influence of theoretically- and developmentally-relevant constructs, including attachment- and nonattachment-related trauma, emotion dysregulation, posttraumatic risk-seeking (PTRS), and other posttraumatic stress symptoms (PTSS), in the trajectory from maltreatment exposure to committing offending behaviors. Specifically, the current study investigated the direct and indirect associations among attachment- and nonattachment-related trauma, emotion dysregulation, PTSS, PTRS, and offending behavior, and whether these relations were moderated by gender or by system status. Additionally, the study investigated the unique contribution of PTRS in predicting offending behavior. Results demonstrated a number of significant differences in means, direct, and indirect effects between crossover and JJ-only youth and boys and girls. Additionally, results of hierarchical Poisson regression demonstrated that PTRS did account for significantly more variance in offending behavior when offending behavior was measured via self-report. Finally, results of mixture modeling identified two distinct risk-seeking groups, and, as predicted, high risk-seekers evidenced significantly greater levels of attachment-related trauma exposure, emotion dysregulation, and PTSS. This study has clinical, research, and theoretical implications for better understanding the risk factors and mechanisms associated with the crossover trajectory

From court to the community: improving access to evidence-based treatment for underserved youth involved in the juvenile legal system at-risk for suicide

Abstract Background Juvenile legal involved youth (JLIY) experience disproportionately high rates of suicidal and self-injurious thoughts and behaviors (SSITB). Many JLIY lack access to evidence-based treatment specifically designed to treat SSITB, thereby increasing the overall risk of suicide. The overwhelming majority of JLIY are not placed in secure facilities and almost all incarcerated youth are eventually released to the community. Consequently, SSITB are a major concern of JLIY residing in the community and it is critical that this population has access to evidence-based treatment for SSITB. Unfortunately, most community mental health providers who treat JLIY have not been trained in evidence-based interventions that are specifically designed to SSITB, which often leads to youth experiencing prolonged periods of SSITB. Training community mental health providers who serve JLIY in the detection and treatment of SSITB shows promise for decreasing the overall suicide risk for JLIY. Methods The current proposal aims to reduce SSITB among JLIY, and thus reduce mental health disparities in this vulnerable and underserved youth population, by increasing access to evidence-based treatment strategies specifically designed to treat SSITB behaviors. We will implement an agency-wide training among at least 9 distinct community mental health agencies that serve JLIY referred to treatment by a statewide court system in the Northeast. Agencies will be trained in an adapted version of the COping, Problem Solving, Enhancing life, Safety, and Parenting (COPES+) intervention. Training will be implemented via a cluster-randomized stepped wedge trial that proceeds through multiple phases. Discussion This research engages multiple systems (i.e., juvenile legal and mental health systems) serving JLIY and has the potential to directly inform treatment practices in juvenile legal and mental health systems. The current protocol has significant public health implications as the primary goals are to reduce SSITB among adolescents involved in the juvenile legal system. By implementing a training protocol with community-based providers to help them learn an evidence-based intervention, this proposal aims to reduce mental health disparities in a marginalized and underserved population. Trial registration osf.io/sq9z