Multiple Informant Cluster Analysis Findings: Which Military-Connected Preschool Aged Children Are Doing Well and Why?

Informed by models of resilience in military families, we explored factors theorized to be associated with social-emotional resilience and risk among young military-connected children. Our secondary analysis of cross-sectional data from 199 military-connected families (n = 346 parents) with at least one preschool-age child in the home (n = 199) led to the empirical identification of two distinct clusters: families with children demonstrating healthy social-emotional functioning and those showing indicators of poor social-emotional functioning. We then identified factors associated with membership in each cluster to determine which deployment and parental wellbeing variables were salient for young child adjustment. Parent psychological health symptoms, parenting, child behavior, and parent-child relationships were measured by parent report and observed interaction. Children with healthier social-emotional functioning were found to be residing with families experiencing less stress and distress. The importance of maternal trauma history is highlighted in our study, as elevated maternal symptoms across all three posttraumatic stress disorder symptom domains were associated with child social-emotional risk. Basic family demographic characteristics did not contribute significantly to the cluster distinctions, nor did military service factors such as active duty, reserve or veteran status, military rank or parent deployment history. These findings are important as the results deemphasize the importance of military service characteristics and highlight the importance of parent wellbeing when considering social-emotional risk and resilience of young children within military families.

Leveraging Leadership in Child Welfare Systems: Large-scale Trauma- and Resilience-informed Training Initiative.

Strengthening the infrastructure of public health systems around trauma-informed principles is crucial to addressing the needs of traumatized children in the child welfare system. In fact, many local and state initiatives have focused on large-scale evaluation studies to determine the value of training direct service staff on trauma foundations. Less yet is known about the benefits of training leaders on trauma foundations, which is crucial given their unique influence on implementation decisions. The current study evaluates a trauma training delivered to leadership-level stakeholders through a large-scale training initiative for the Los Angeles County Department of Children and Family Services. Findings indicated that leaders improved in trauma knowledge from baseline to post-training and reported changes in their professional wellbeing and leadership approach after the reflective training component. The leadership trauma program may have positive downstream implications for direct service staff, organizational culture, and child and family outcomes.

A Trauma-Informed, Family-Centered, Virtual Home Visiting Program for Young Children: One-Year Outcomes.

Military-connected families face many challenges associated with military life transitions, including deployment separations. We report on a randomized controlled trial to evaluate the efficacy of Families OverComing Under Stress-Early Childhood (FOCUS-EC) delivered through an in-home, virtual telehealth platform. FOCUS-EC is a trauma-informed, family-centered preventive intervention designed to promote family resilience and well-being. Military-connected families with 3- to 6-year-old children (194 mothers; 155 fathers; 199 children) were randomized to FOCUS-EC or an online education condition. Parent psychological health symptoms, child behavior, parenting, and parent-child relationships were examined by parent-report and observed interaction tasks for up to 12 months. Longitudinal regression models indicated that FOCUS-EC families demonstrated significantly greater improvements than online education families in parent-reported and observational measures of child behavior, parenting practices, and parent-child interaction, as well as greater reductions in parent posttraumatic stress symptoms. Findings provide support for the benefit of a virtually-delivered preventive intervention for military-connected families.

Factors associated with response and remission from depression at 6-months of treatment in a retrospective cohort treated within an integrated care program.

BACKGROUND: Depression causes significant morbidity, which impacts mental health, overall general health outcomes, everyday functioning and quality of life. This study aims to contribute to knowledge in the field through enhanced understanding of factors that influence depression response and remission, with consideration for design of treatment services to optimize depression outcomes within integrated care programs. METHODS: Using routine behavioral health screening and electronic health record data, we identified a retrospective cohort consisting of 615 adult patients receiving depression treatment within an integrated care program. Cohort member Patient Health Questionnaire (PHQ-9) data was analyzed for the 6 months following initiation of treatment. Multinomial regression models were estimated to identify factors associated with depression treatment response (PHQ-9 < 10) and remission (PHQ-9 < 5). RESULTS: At 6 months, 47% of patients demonstrated treatment response and 16% demonstrated remission. Baseline trauma symptoms and suicidal ideation were significantly associated with decreased odds of achieving remission (Odds Ratio (95% CI) [OR] = 0.45 (0.23, 0.88) and OR = 0.49 (0.29, 0.82), respectively). In fully adjusted models, baseline suicidal ideation remained significant (OR = 0.53 (0.31, 0.89)) and some evidence of an association persisted for baseline trauma symptoms (OR = 0.51 (0.25, 1.01)). CONCLUSIONS: After controlling for baseline depression symptoms, the presence of suicidal ideation is associated with reduced likelihood of remission. Increased understanding of factors associated with depression treatment outcomes may be employed to help guide the delivery and design of clinical services. Alongside routine screening for co-morbid anxiety, suicidal ideation and traumatic stress should be assessed and considered when designing depression treatment services.

Education Research: Evaluation of curriculum to teach resilience skills to neurology residents.

OBJECTIVE: To evaluate feasibility and acceptability of a health professional resilience skills training program with neurology residents. METHODS: The curriculum consists of five 1-hour-long modules that included the following skills: reflective narrative practices, emotion regulation, communication with highly distressed individuals, boundary management, and the identification of depression and trauma. Using a web-based survey tool, we administered the Brief Resilience Scale (BRS) and Abbreviated Maslach Burnout Inventory (aMBI) at baseline, in addition to a pre- and post-survey assessing change in beliefs and self-efficacy, as well as satisfaction with the intervention. Means were compared using the Wilcoxon rank-sum and signed rank tests. RESULTS: Twenty-two residents representing each year of training completed the pre-survey; 41% were women. Subscale scores on the aMBI revealed that 50% had moderate or high emotional exhaustion, 41% had moderate depersonalization, and 37% had moderate or low personal accomplishment, though 77.3% reported high career satisfaction. Female residents had lower scores on the BRS (mean 3.26 vs 3.88, p < 0.05), though scores on aMBI subscales did not differ by sex. Scores did not differ by year of training. Sixteen residents completed both the pre- and post-survey. Significant increases were detected in 4 of 9 self-efficacy statements. Seventy-one percent of residents were satisfied or extremely satisfied with the training. CONCLUSIONS: Residents were satisfied with the curriculum and reported improved ability to identify and cope with work-related stress. Further study is needed to evaluate the influence of skills adoption and practice on resilience and burnout.

Acontecimientos vitales estresantes y nivel de riesgo psicosomático en pacientes pertenecientes al club de diabéticos del Hospital Regional de Sonsonate ISSS / Stressful life events and level of psychosomatic risk in patients belonging to the Diabetic Club of the Regional Hospital of the ISSS of Sonsonate

Existen diferentes publicaciones de diversos países que han concluido que existe una relación en cuanto a la presencia de estrés y la alteración de la enfermedad, así mismo se concluyó que existe un mejor control de la glicemia y mejor control de la enfermedad posterior a la aplicación de ciertos tipos de terapias las cuales contribuyen a un mejor manejo del estrés lo que conlleva a una mejoría en la calidad de vida. Partiendo de lo anterior, se realizó un estudio tomando como muestra los pacientes adultos mayores que pertenecen al club de diabéticos del Hospital Regional Sonsonate, que fueron en total 37, en los que el coordinador del grupo observó una asistencia irregular de algunos miembros y algunos cambios de actitud, dichos pacientes quienes tienen una reunión semanal los días jueves en el auditórium de dicho Hospital, donde se les aplicó el instrumento que constaba de un Consentimiento Informado y la Escala de Acontecimientos Vitales Estresantes de Holmes y Rahe la cual es una escala creada en 1967 que consta de 43 eventos vitales con mayor influencia en la población, determinando la posibilidad que cada paciente tiene de presentar una enfermedad psicosomática o una descompensación de una enfermedad ya existente. De la recopilación de datos se obtuvo que un 32% se encuentran en riesgo leve, un 36 % en riesgo intermedio y 32% en riesgo alto. Además se encontró que los eventos vitales más frecuentes son: 1) heridas o enfermedades personales, 2) Muerte de un familiar cercano, 3) Cambio en la salud de un miembro de la familia, 4) Cambio en la situación financiera y 5) Cambio en los hábitos alimenticios No hay predominio de un riesgo especifico sino que se puede observar una equidad entre el porcentaje obtenido