面向21世纪的灾害心理健康援助

美国灾害心理援助模型和经验教训 如何更好提升灾后心理健康援助 未来灾害心理援助的思考 互联网和移动科技的作用 </ul

A systematic digital approach to implementation and dissemination of eating disorders interventions to large populations identified through online screening: Implications for post-traumatic stress

Background: We describe an approach to implementation and dissemination that focuses on changing outcomes variables within a large, defined population and attempts to provide cost-effective opportunities and resources-which might include the provision of both digital and traditional interventions-to address individual needs and interests. We present a case example of how aspects of this model are being applied to increase reach, engagement and outcomes for individuals who complete a national eating disorders screen, and are likely to have an eating disorder but who are not in treatment. We then describe how this model can apply to post-traumatic stress (PTS) and conclude with a discussion of limitations and issues with the model. Methods: The National Eating Disorders Association (NEDA) provides online screening for eating disorders. Results: From February 2017 through March 2018, over 200,000 individuals completed the NEDA screen. Of these, 96% screened positive or at risk for an eating disorder, and most of those who screened positive for a clinical/subclinical eating disorder were not currently in treatment. Less than 10% engaged in self-help or guided self-help online digital program, or expressed interest in calling a helpline for referral to treatment. Conclusions: A systematic digital approach to implementation and dissemination has the potential to increase the number of individuals who benefit from interventions in defined populations. Uptake rates need to be improved

Measurement of a Model of Implementation for Health Care: Toward a Testable Theory

Greenhalgh et al. used a considerable evidence-base to develop a comprehensive model of implementation of innovations in healthcare organizations [1]. However, these authors did not fully operationalize their model, making it difficult to test formally. The present paper represents a first step in operationalizing Greenhalgh et al.\u27s model by providing background, rationale, working definitions, and measurement of key constructs.A systematic review of the literature was conducted for key words representing 53 separate sub-constructs from six of the model\u27s broad constructs. Using an iterative process, we reviewed existing measures and utilized or adapted items. Where no one measure was deemed appropriate, we developed other items to measure the constructs through consensus

Iraq War Clinician Guide 46 Medical Casualty Evacuees V. Treatment of Medical Casualty Evacuees

Men and women evacuated from the war zone due to physical injury are at higher-risk than other soldiers for development of PTSD and other trauma-related problems. If the VA serves as a care facility for Iraq War medical casualties, it will be important that clinical attention be given not just to their physical recovery and health, but to their mental health needs. Failure to do so may be to lose a significant and unique opportunity for early intervention to prevent development of more chronic emotional and behavioral problems. In this section of the Iraq War Clinician Guide we outline some considerations related to the integration of mental health care with physical care of recently evacuated Iraq War veterans. (See also Chapter IV for general treatment considerations). This kind of activity represents a challenge for VA mental health professionals. While VA PTSD, behavioral medicine, and other mental health practitioners are familiar with delivery of traumatic stress assessment and treatment to help-seeking veterans with chronic PTSD or general health problems, they are less likely to have delivered such services to individuals who have been injured during very recent exposure to traumas of war. More generally, focus on treatment of physical problems is often accompanied by a strong desire on the part of both patient and provider to avoid discussing emotional issues (Scurfield &amp; Tice, 1991). Offering Comprehensive Care Traumatic stress-related interventions should be presented as part of routine care given to all patients, and framed as a component of a comprehensive response to the needs of the veteran, in which the whole person is treated. Stress-related education will be helpful for all patients, including those not showing traumatic stress reactions, because health problems inevitably bring stress and challenges in coping. Most medical casualties will not be seeking mental health care. Many can be expected to be reluctant to acknowledge their emotional distress and some will be concerned that a mental health diagnosis (e.g., PTSD) in their medical record may harm their chances of future promotion. Therefore, clinicians need to minimize mental health jargon, avoid pathologizing common stress reactions, and be thoughtful about assignment of DSM-IV diagnoses

From Resilience and Restoration to Resistance and Resource Caravans: A Developmental Framework for Advancing the Disaster Field.

In a major consensus paper, Hobfoll et al. (2007) drew upon an extensive review of the disaster and mass violence literature to propose a core set of five empirically-supported foci for intervention in the early to mid-term post-trauma stages. These foci included promoting a sense of safety, calming, self and community efficacy, connectedness, and hope. The paper is notable for its integration of guiding theory and practical implications. The impact of this paper over the past 15 years (with over 1,300 citations to date) has been significant and widespread. Consistent with social psychologist Kurt Lewin’s (1943) maxim that “there is nothing as practical as a good theory,” the consensus paper illustrates the utility of a guiding conceptual framework for generating clear, logical, and practical implications for disaster planning and intervention

Patterns of childhood trauma and psychopathology among Chinese rural-to-urban migrant children

Background: Exposure to childhood trauma can cause psychopathology and negative psychosocial outcomes across the lifespan. Rural-to-urban migrant children are commonly exposed to traumatic experiences (TEs). However, no study has comprehensively examined patterns of childhood trauma in Chinese culture. The current study aimed to examine patterns of childhood trauma exposure among Chinese rural-to-urban migrant children. Methods: A large-scale (N = 15,890) cross-sectional survey of rural-to-urban migrant workers&#39; children in grades 4 to 9 was conducted in Beijing. Childhood TEs, including accidents and injuries, interpersonal violence, and vicarious trauma, as well as demographics and internalizing and externalizing behaviors, were measured. Results: Four patterns of childhood trauma were found: low trauma exposure (60.4%), vicarious trauma exposure (23.9%), domestic violence exposure (10.5%), and multiple trauma exposure (5.3%). Age, gender, parents&#39; marital status, father&#39;s education level, family support and peer support differentiated the four TE patterns. Both internalizing and externalizing behaviors were more severe in patterns with more types of TEs. Conclusions: Our findings provide a better understanding of childhood trauma in Chinese culture and the relationship between TEs and mental health. Clinicians and policy makers should tailor prevention and treatment programs according to different patterns of victimization.</p

Posttraumatic stress disorder following the 2008 Wenchuan earthquake: A 10-year systematic review among highly exposed populations in China

Background: The 2008 Wenchuan earthquake was unprecedented in Chinese history both in terms of the magnitude of the quake itself and the scale of human suffering. Following the disaster, researchers reported on a wide range of mental health outcomes, especially posttraumatic stress disorder (PTSD). In this review, we assess the cumulative body of research evidence about PTSD across the first 10 years following the earthquake. Methods: We searched the literature in the PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) databases (from May 2008 to February 2018) using Wenchuan earthquake and PTSD as keywords. Results: We selected 58 relevant studies. Published findings from the selected period suggested a substantial burden of PTSD on highly exposed survivors. Studies have found that symptoms of PTSD have been associated with a range of risk factors, including sociodemographic factors, trauma exposure characteristics, post-disaster cognitive and emotional states, and social support. Studies have explored the factor structure of PTSD in the affected Chinese population, and researchers have developed a Chinese self-report measure of PTSD symptoms. Several treatments for PTSD have been evaluated, including some indigenous intervention methods. Limitations: Only a relatively small number of the studies used longitudinal assessments, and the consistency and effectiveness of measurement tools for PTSD require further exploration. More rigorous investigations of the effectiveness of interventions for the prevention and treatment of PTSD are needed. Conclusion: The 10-year body of literature is important for the future deployment of disaster relief and an increased understanding of PTSD in China.</p

Cognitive behavioral therapies for trauma, 2nd ed./ Edit.: Victoria C. Follette

xx, p. 472.: ill.; 24 c

Machine Learning Model to Predict Assignment of Therapy Homework in Behavioral Treatments: Algorithm Development and Validation

BackgroundTherapeutic homework is a core element of cognitive and behavioral interventions, and greater homework compliance predicts improved treatment outcomes. To date, research in this area has relied mostly on therapists’ and clients’ self-reports or studies carried out in academic settings, and there is little knowledge on how homework is used as a treatment intervention in routine clinical care. ObjectiveThis study tested whether a machine learning (ML) model using natural language processing could identify homework assignments in behavioral health sessions. By leveraging this technology, we sought to develop a more objective and accurate method for detecting the presence of homework in therapy sessions. MethodsWe analyzed 34,497 audio-recorded treatment sessions provided in 8 behavioral health care programs via an artificial intelligence (AI) platform designed for therapy provided by Eleos Health. Therapist and client utterances were captured and analyzed via the AI platform. Experts reviewed the homework assigned in 100 sessions to create classifications. Next, we sampled 4000 sessions and labeled therapist-client microdialogues that suggested homework to train an unsupervised sentence embedding model. This model was trained on 2.83 million therapist-client microdialogues. ResultsAn analysis of 100 random sessions found that homework was assigned in 61% (n=61) of sessions, and in 34% (n=21) of these cases, more than one homework assignment was provided. Homework addressed practicing skills (n=34, 37%), taking action (n=26, 28.5%), journaling (n=17, 19%), and learning new skills (n=14, 15%). Our classifier reached a 72% F1-score, outperforming state-of-the-art ML models. The therapists reviewing the microdialogues agreed in 90% (n=90) of cases on whether or not homework was assigned. ConclusionsThe findings of this study demonstrate the potential of ML and natural language processing to improve the detection of therapeutic homework assignments in behavioral health sessions. Our findings highlight the importance of accurately capturing homework in real-world settings and the potential for AI to support therapists in providing evidence-based care and increasing fidelity with science-backed interventions. By identifying areas where AI can facilitate homework assignments and tracking, such as reminding therapists to prescribe homework and reducing the charting associated with homework, we can ultimately improve the overall quality of behavioral health care. Additionally, our approach can be extended to investigate the impact of homework assignments on therapeutic outcomes, providing insights into the effectiveness of specific types of homework