A qualitative examination of weapon violence against teachers: A theoretical framework and analysis.

Weapon violence in schools is a pressing concern with serious consequences. In this study, we propose and evaluate a theoretical framework of school-based weapon violence comprised of contributors, triggers, and motivation leading to weapon behaviors, taking into account weapon type, origin, and availability. This framework provides a foundation to investigate the multifaceted nature of weapon violence in schools. Specifically, we examine the weapon violence experiences of 417 U.S. teachers based on their reports of their most upsetting experiences with violence in their schools from various aggressors (i.e., students, parents, colleagues). Qualitative open-ended survey data were coded in NVivo after achieving strong interrater reliability (Gwet's agreement coefficient with first-order chance correction, AC1 = .97; κ = .80), and analyses were guided by the proposed theoretical framework. Results indicated that individual, school, peer, family, and community conditions contributed to situational triggers (teacher or other school-stakeholder actions), and aggressor motivation was typically instrumental or expressive. The type and origin of weapons also played a role in weapon behaviors of carrying, threats, and usage. Aggressors often used readily available objects (e.g., chair, pencil) as weapons against teachers in addition to traditional weapons (e.g., knives, guns). Findings suggest that weapon violence in schools requires a broader conceptualization beyond traditional weapons and violence between students. This study advances our understanding of pathways to weapon behaviors for prevention and intervention. Implications of findings for school-stakeholder training and policies are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Meta-analyses of teacher-delivered trauma-based and trauma-informed care interventions.

OBJECTIVE: Children impacted by adversity and trauma often experience psychological, emotional, behavioral, and academic difficulties. To address these concerns, there is a growing call for trauma-informed school systems to better support students with trauma histories. Teacher involvement in trauma-informed approaches is vital but understudied. METHOD: We conducted a meta-analytic review of the literature published between 1990 and 2019 to evaluate outcomes for teachers and students involved in teacher-delivered trauma interventions. Inclusion criteria specified peer-reviewed studies, dissertations, and nonacademic reports that used randomized controlled and nonrandomized pre-post intervention designs. RESULTS: We found 20 articles, of which, 12 were pre-post and eight were randomized designs. Seven articles specifically incorporated trauma-informed care (TIC), whereas the other 13 were traditional trauma-based mental health interventions. We conducted meta-analyses to assess student trauma symptom severity and teacher knowledge of trauma-informed practices. Results revealed that after participating in teacher-delivered trauma interventions, students reported significantly reduced trauma symptom severity postintervention and less severity of symptoms than students in the control conditions. There were no differences between trauma-based and TIC intervention student outcomes. Teachers exhibited greater knowledge acquisition after participating in TIC interventions. CONCLUSION: These findings suggest that trauma interventions, both with and without explicitly referencing TIC principles, are evidence-based in the context of teacher-facilitated school interventions. Additional research is needed to evaluate the organizational benefits of TIC, particularly to determine if the benefits of trauma-informed schools extend beyond students. We conclude with research, policy, and practice recommendations for transformative change to create trauma-informed schools. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Mechanisms of action for stigma reduction among primary care providers following social contact with service users and aspirational figures in Nepal: an explanatory qualitative design.

BACKGROUND: There are increasing initiatives to reduce mental illness stigma among primary care providers (PCPs) being trained in mental health services. However, there is a gap in understanding how stigma reduction initiatives for PCPs produce changes in attitudes and clinical practices. We conducted a pilot randomized controlled trial of a stigma reduction intervention in Nepal: REducing Stigma among HealthcAre Providers (RESHAPE). In a previous analysis of this pilot, we described differences in stigmatizing attitudes and clinical behaviors between PCPs receiving a standard mental health training (mental health Gap Action Program, mhGAP) vs. those receiving an mhGAP plus RESHAPE training. The goal of this analysis is to use qualitative interview data to explain the quantitative differences in stigma outcomes identified between the trial arms. METHODS: PCPs were randomized to either standard mental health training using mhGAP led by mental health specialists or the experimental condition (RESHAPE) in which service users living with mental illness shared photographic recovery narratives and participated in facilitated social contact. Qualitative interviews were conducted with PCPs five months post-training (n = 8, standard mhGAP training; n = 20, RESHAPE). Stigmatizing attitudes and clinical practices before and after training were qualitatively explored to identify mechanisms of change. RESULTS: PCPs in both training arms described changes in knowledge, skills, and confidence in providing mental healthcare. PCPs in both arms described a positive feedback loop, in which discussing mental health with patients encouraged more patients to seek treatment and open up about their illness, which demonstrated for PCPs that mental illness can be treated and boosted their clinical confidence. Importantly, PCPs in the RESHAPE arm were more likely to describe a willingness to treat mental health patients and attributed this in part to social contact with service users during the training. CONCLUSIONS: Our qualitative research identified testable mechanisms of action for stigma reduction and improving clinical behavior: specifically, recovery stories from service users and social engagement led to greater willingness to engage with patients about mental illness, triggering a feedback loop of more positive experiences with patients who benefit from mental healthcare, which further reinforces willingness to deliver mental healthcare. Trial registration ClinicalTrials.gov identifier, NCT02793271.

Centering mental health in society: A human rights approach to well-being for all.

Applying a human rights lens to mental health and well-being will improve the systems that govern and operate U.S. society. Achieving this requires learning from successful approaches and scaling up the implementation of effective strategies that promote equity by actively addressing determinants and barriers across systems that impede overall health. As a country, the U.S. has shown significant success in innovation but has failed at taking successful programs and initiatives to scale. Having endured over a year of loss in education, social connection, and routines, the COVID-19 pandemic illuminated America's deeply rooted structural inequities that have worsened population mental health and well-being. Integrating mental health into institutions and systems, while recovering and rebuilding, must be at the forefront to provide a path for transformation. Three recommendations are derived from the strategies and initiatives described throughout this article that offer tangible steps for achieving wellbeing as a human right: 1. Embed mental health within and across all systems, and expand its definition across the continuum; 2. Prioritize prevention and health promotion through person-centered and community-driven strategies; and 3. Expand the diversification and training of the mental health workforce across sectors. The inequities addressed in this article are not the products of a global pandemic. Instead, they result from historical oppression, injustice, and inaction, exacerbated by the current context. Embedding a human rights approach to mental health in the United States is fundamental to individual and community well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Treatment Preferences for Pharmacological versus Psychological Interventions among Primary Care Providers in Nepal: Mixed Methods Analysis of a Pilot Cluster Randomized Controlled Trial.

There is increasing evidence supporting the effectiveness of psychological interventions in low- and middle-income countries. However, primary care providers (PCPs) may prefer treating patients with medication. A secondary exploratory analysis of a pilot cluster randomized controlled trial was conducted to evaluate psychological vs. pharmacological treatment preferences among PCPs. Thirty-four health facilities, including 205 PCPs, participated in the study, with PCPs in 17 facilities assigned to a standard version of the mental health Gap Action Programme (mhGAP) training delivered by mental health specialists. PCPs in the other 17 facilities received mhGAP instruction delivered by specialists and people with lived experience of mental illness (PWLE), using a training strategy entitled Reducing Stigma among HealthcAre ProvidErs (RESHAPE). Pre- and post- intervention attitudes were measured through quantitative and qualitative tools. Qualitative interviews with 49 participants revealed that PCPs in both arms endorsed counseling's benefits and collaboration within the health system to provide counseling. In the RESHAPE arm, PCPs were more likely to increase endorsement of statements such as "depression improves without medication" (F = 9.83, p < 0.001), "not all people with depression must be treated with antidepressants" (χ2 = 17.62, p < 0.001), and "providing counseling to people who have alcohol abuse problems is effective" (χ2 = 26.20, p < 0.001). These mixed-method secondary findings from a pilot trial suggest that in-person participation of PWLE in training PCPs may not only reduce stigma but also increase PCPs' support of psychological interventions. This requires further investigation in a full-scale trial.