Trauma histories among justice-involved youth: findings from the National Child Traumatic Stress Network.

BackgroundUp to 90% of justice-involved youth report exposure to some type of traumatic event. On average, 70% of youth meet criteria for a mental health disorder with approximately 30% of youth meeting criteria for post-traumatic stress disorder (PTSD). Justice-involved youth are also at risk for substance use and academic problems, and child welfare involvement. Yet, less is known about the details of their trauma histories, and associations among trauma details, mental health problems, and associated risk factors.ObjectiveThis study describes detailed trauma histories, mental health problems, and associated risk factors (i.e., academic problems, substance/alcohol use, and concurrent child welfare involvement) among adolescents with recent involvement in the juvenile justice system.MethodThe National Child Traumatic Stress Network Core Data Set (NCTSN-CDS) is used to address these aims, among which 658 adolescents report recent involvement in the juvenile justice system as indexed by being detained or under community supervision by the juvenile court.ResultsAge of onset of trauma exposure was within the first 5 years of life for 62% of youth and approximately one-third of youth report exposure to multiple or co-occurring trauma types each year into adolescence. Mental health problems are prevalent with 23.6% of youth meeting criteria for PTSD, 66.1% in the clinical range for externalizing problems, and 45.5% in the clinical range for internalizing problems. Early age of onset of trauma exposure was differentially associated with mental health problems and related risk factors among males and females.ConclusionsThe results indicate that justice-involved youth report high rates of trauma exposure and that this trauma typically begins early in life, is often in multiple contexts, and persists over time. Findings provide support for establishing trauma-informed juvenile justice systems that can respond to the needs of traumatized youth

A qualitative study of the experiences and perceptions of adults with chronic musculoskeletal conditions following a 12-week Pilates exercise programme

Introduction The aim of the present study was to explore the experiences and perceptions of adult patients with chronic musculoskeletal conditions following a Pilates exercise programme. A qualitative approach was taken to both data collection and analysis, with alignment to the philosophy of interpretive phenomenology. Participants included 15 women and seven men with a range of chronic musculoskeletal conditions, including nonspecific low back pain, peripheral joint osteoarthritis and a range of postsurgical conditions. The age range was from 36 years to 83 years, and the mean age was 57 years (standard deviation 14.1 years). Methods Data were collected via digital recordings of four focus groups in three North‐West of England physiotherapy clinics. The data were transcribed verbatim and then analysed using a thematic framework. Data were verified by a researcher and randomly selected participants, and agreement was achieved between all parties. Results The results were organized into five main themes: physical improvements; Pilates promotes an active lifestyle: improved performance at work and hobbies; psychosocial benefits and improved confidence; increased autonomy in managing their own condition; and motivation to continue with exercise. Conclusion The study was the first to investigate individual perceptions of the impact of Pilates on the daily lives of people with chronic conditions. The Pilates‐based exercise programme enabled the participants to function better and manage their condition more effectively and independently. Further to previous work, the study revealed psychological and social benefits which increase motivation to adhere to the programme and promote a healthier lifestyle

Four patients with a history of acute exacerbations of COPD: implementing the CHEST/Canadian Thoracic Society guidelines for preventing exacerbations

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The development of the British Red Cross' psychosocial framework: 'calmer'

This paper presents the history, development and approach of the new psychosocial framework which in 2008 was adopted by the British Red Cross, and a piece of research designed to review its fitness for purpose as an educational tool. The framework CALMER is a single, overarching approach for considering and delivering psychosocial services across all of the British Red Cross. It is being included in all relevant training programmes, such as within first aid and psychosocial support and within services in emergency response, event first aid, health and social care, international tracing and message and refugee services and across human resources. The framework includes six prompts which should be followed sequentially, with guidance on facilitative behaviours within each. The research considered the levels of confidence and worry of participants on one day training programmes delivered to three different groups of personnel in three different countries. While finding support for the CALMER framework, further recommendations are made for future research

Randomized control trial of Teaching Recovery Techniques in rural occupied Palestine:Effect on adolescent dissociation

The current study assessed the effect of a cognitive behavioral group intervention, Teaching Recovery Techniques (TRT), for adolescents with high levels of posttraumatic stress (n = 154), from villages in occupied Palestine. A randomized control trial involved standardized measures to assess war stressors, posttraumatic stress, depression, and dissociation. Program fidelity was measured by presenter and observer ratings and program delivery cost was calculated per adolescent. High levels of traumatic exposure, dissociation, and posttraumatic stress were found. In comparison to a Wait List group (n = 75), TRT adolescents reported significantly fewer posttraumatic stress symptoms post-intervention. Depression and dissociation remained stable for TRT adolescents, but worsened for Wait List. Given the high returns and low costs, this costbenefit analysis makes a clear case for TRT to be delivered throughout the West Bank. Longitudinal evaluation is needed to assess adolescent traumatization and the impact of TRT within a context of ongoing violence.<br/

Schema therapy for emotional dysregulation: Theoretical implication and clinical applications

The term emotional dysregulation refers to an impaired ability to regulate unwanted emotional states. Scientific evidence supports the idea that emotional dysregulation underlies several psychological disorders as, for example: personality disorders, bipolar disorder type II, interpersonal trauma, anxiety disorders, mood disorders and posttraumatic stress disorder. Emotional dysregulation may derive from early interpersonal traumas in childhood. These early traumatic events create a persistent sensitization of the central nervous system in relation to early life stressing events. For this reason, some authors suggest a common endophenotypical origin across psychopathologies. In the last 20 years, cognitive behavioral therapy has increasingly adopted an interactiveontogenetic view to explain the development of disorders associated to emotional dysregulation. Unfortunately, standard Cognitive Behavior Therapy (CBT) methods are not useful in treating emotional dysregulation. A CBT-derived new approach called Schema Therapy (ST), that integrates theory and techniques from psychodynamic and emotion focused therapy, holds the promise to fill this gap in cognitive literature. In this model, psychopathology is viewed as the interaction between the innate temperament of the child and the early experiences of deprivation or frustration of the subject\u2019s basic needs. This deprivation may lead to develop early maladaptive schemas (EMS), and maladaptive Modes. In the present paper we point out that EMSs and Modes are associated with either dysregulated emotions or with dysregulatory strategies that produce and maintain problematic emotional responses. Thanks to a special focus on the therapeutic relationship and emotion focused-experiential techniques, this approach successfully treats severe emotional dysregulation. In this paper, we make several comparisons between the main ideas of ST and the science of emotion regulation, and we present how to conceptualize pathological phenomena in terms of failed regulation and some of the ST strategies and techniques to foster successful regulation in patients

Differential Effects of Exposure to Social Violence and Natural Disaster on Children's Mental Health

Disaster mental health, particularly postdisaster child mental health, is neglected in India. This study compares the impact of a natural disaster versus a spate of communal riots that occurred in Gujarat, India on January 26, 2001, and February 2002 to June 2002, respectively. Children aged 8-15 years from highly exposed earthquake sites (n = 128) and riot sites (n = 171) were approached for participation. A matching control sample of 351 nontrauma-exposed children was sought to compare with the trauma groups. Trauma and postdisaster adversities were studied using the UCLA disaster trauma tool; Goodman's Strengths and Difficulties Questionnaire was used to assess adjustment difficulties. Spearman's correlations were calculated to find associations between trauma items on UCLA's brief trauma scale and Strengths and Difficulties Questionnaire items. Results suggest that 7.6% of the earthquake sample and 38.7% from the riots sample manifested clinically significant mental health problems. The earthquake sample had 24.8% of those above clinical cutoff for probable posttraumatic stress disorder and the riots sample had 27.3% children who displayed posttraumatic stress symptoms. Children exposed to violence were psychologically more affected and in the presence of postdisaster adversities, posttraumatic stress symptoms persisted long term. This finding should enable development of differential psychotherapeutic interventions for children exposed to extreme events

Criança, violência e saúde: desafios e questões atuais

This paper examines challenges and current issues involved in measuring exposure to different types of violence which are associated mental health problems in children and adolescents. Standardized measures suitable for epidemiological studies, selected based on their relevance in the current literature, are briefly described and commented. The assessment of child's exposure to violence may focus on a specific event (e.g., kidnapping), a specific context (e.g., war) or even of a certain type of exposure (e.g., intrafamilial physical violence). The assessment of child mental health after exposure to violence has traditionally focused on posttraumatic stress disorder (PTSD) - most frequently measured through non-diagnostic scales. However, other mental health reactions may be present and screening as well as diagnostic instruments which may be used to assess these reactions are also described. Two issues of emerging importance - the assessment of impairment and of traumatic grief in children - are also presented. Availability of culturally appropriate instruments is a crucial step towards proper identification of child mental health problems after exposure to violence.Este artigo examina os desafios e perspectivas atuais envolvidos na mensuração da exposição a diferentes tipos de violência e problemas de saúde mental em crianças e adolescentes. Instrumentos padronizados apropriados para estudos epidemiológicos, selecionados com base em sua relevância na literatura, são brevemente descritos e comentados. A avaliação de exposição à violência em crianças pode dizer respeito a um evento específico (como sequestro) ou um contexto específico (como guerra) ou mesmo um determinado tipo de exposição (como violência física intrafamiliar). A avaliação da saúde mental infantil após a exposição à violência tradicionalmente concentrou-se na avaliação do transtorno de estresse pós-traumático (TEPT) - freqüentemente avaliado através de escalas não-diagnósticas. Porém, outras reações psicológicas podem ocorrer e instrumentos que podem ser usados para avaliar estas reações também são descritos neste artigo. Dois tópicos de importância emergente - a avaliação de prejuízo funcional e do pesar traumático em crianças - são também apresentados. Instrumentos culturalmente apropriados são essenciais para a identificação de problemas de saúde mental em crianças após a exposição à violência.Division of Child and Adolescent PsychiatryUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

Service planning and delivery outcomes of home adaptations for ageing in the UK

In response to the impact of demographic change on the healthcare system, ‘ageing in place’ was introduced as a national policy to support elderly people living independently in their homes. Housing adaptation is essential for successful independent living and has been given increased political priority. However, adaptation policies and practice vary regionally, reflecting statutory limits, policy choices and local planning. This study investigated the current status of adaptation provision in different regions in the UK and assessed the effectiveness of local service planning and management. A mixed-methods sequential explanatory research strategy was employed. In the first quantitative phase, a questionnaire survey was carried out involving all 378 local authorities in England, Scotland and Wales. This was followed by a second qualitative phase involving individual interviews with five professionals and two clients and a focus group meeting with six key stakeholders. The study found that the current number of adaptations was relatively small compared with potential demands in most local areas, as was funding for adaptations. On the operational side, the adaptation process was fragmented, involving different service groups in many local authorities. There were disconnections between these groups, which often caused inefficiencies and poor effectiveness. Moving forward, local authorities need to have a clear vision of the overall need for adaptations and allocate sufficient resources. Practical guidelines are also needed for better integrated working and performance management

Aging in Place: Evolution of a Research Topic Whose Time Has Come

Over the past 30 years, policy makers and professionals who provide services to older adults with chronic conditions and impairments have placed greater emphasis on conceptualizing aging in place as an attainable and worthwhile goal. Little is known, however, of the changes in how this concept has evolved in aging research. To track trends in aging in place, we examined scholarly articles published from 1980 to 2010 that included the concept in eleven academic gerontology journals. We report an increase in the absolute number and proportion of aging-in-place manuscripts published during this period, with marked growth in the 2000s. Topics related to the environment and services were the most commonly examined during 2000–2010 (35% and 31%, resp.), with a substantial increase in manuscripts pertaining to technology and health/functioning. This underscores the increase in diversity of topics that surround the concept of aging-in-place literature in gerontological research