Preventing opioid use among justice-involved youth as they transition to adulthood: leveraging safe adults (LeSA).

BACKGROUND: Juvenile justice (JJ) youth are at high risk of opioid and other substance use (SU), dysfunctional family/social relationships, and complex trauma. The purpose of the Leveraging Safe Adults (LeSA) Project is to examine the effectiveness of Trust-Based Relational Intervention® (TBRI®; leveraging family systems by providing emotional and instrumental guidance, support, and role modeling) in preventing opioid and other SU among youth after release from secure residential facilities. METHODS: An effectiveness-implementation Hybrid Type 1 design is used to test the effectiveness of TBRI for preventing non-medical use of opioids among JJ-youth (delayed-start at the site level; a randomized controlled trial at participant level) and to gain insight into facility-level barriers to TBRI implementation as part of JJ re-entry protocols. Recruitment includes two samples (effectiveness: 360 youth/caregiver dyads; implementation: 203 JJ staff) from nine sites in two states over 3 years. Participant eligibility includes 15 to 18-year-olds disposed to community supervision and receiving care in a secure JJ facility, without active suicide risk, and with one caregiver willing to participate. Effectiveness data come from (1) youth and caregiver self-report on background, SU, psychosocial functioning, and youth-caregiver relationships (Months 0, 3, 6, 12, and 18), youth monthly post-release check-ins, and caregiver report on youth psychological/behavioral symptoms, and (2) JJ facility records (e.g., recidivism, treatment utilization). Fidelity assessment includes post-session checklists and measures of TBRI strategy use. Collected four times over four years, implementation data include (1) JJ staff self-report on facility and staff characteristics, use of trauma-informed care and TBRI strategies, and (2) focus groups (line staff, leadership separately) on use of trauma-informed strategies, uptake of new interventions, and penetration, sustainment, and expansion of TBRI practices. DISCUSSION: The LeSA study is testing TBRI as a means to empower caregivers to help prevent opioid use and other SU among JJ-youth. TBRI's multiple components offer an opportunity for caregivers to supplement and extend gains during residential care. If effective and implemented successfully, the LeSA protocol will help expand the application of TBRI with a wider audience and provide guidance for implementing multi-component interventions in complex systems spanning multiple contexts. TRIAL REGISTRATION: ClinicalTrials.gov NCT04678960 ; registered November 11, 2020; https://clinicaltrials.gov/ct2/show/NCT04678960 .

Attention focus and self-touch in toddlers: The moderating effect of attachment security.

The superior self-regulation and attention-regulation abilities of securely attached children have been repeatedly demonstrated. However, the mechanisms that allow securely attached children to exhibit higher levels of attention focus than insecurely attached (anxious-ambivalent and anxious-avoidant) children need to be explored. One possible mechanism that has been hypothesized to play a role in focusing attention is self-touch. Previous research has shown that 10-year-old children exhibit more bilateral self-touch (i.e., both hands are simultaneously moving onto each other or on the body, and both hands are in contact with each other or with the body), but not lateral self-touch (i.e., one hand is moving on the other hand or on the body, and the hand is in contact with the other hand or with the body), when they focus attention on a task. Because bilateral coordination is still developing during childhood, we expected that lateral self-touch, instead of bilateral self-touch, may be associated with attention focus for toddlers. The objectives of the present study were to examine whether securely attached toddlers exhibit more self-touch, particularly lateral self-touch, while they focus on a task than while they do not focus on a task. We expected to find that the association between lateral self-touch and attention focus is not as strong for insecurely attached toddlers. Data from forty-nine mother-child dyads were employed for analyses. The attachment classification of the children was determined using the Strange Situation. The duration of attention focus and self-touch behavior during a reading task were coded. An association between lateral self-touch and attention focus was found for children of all attachment classifications. This association was particularly strong for securely attached children. We discuss the possibility that securely attached toddlers may use lateral self-touch to regulate attention.

MENTAL STATE LANGUAGE DEVELOPMENT: THE LONGITUDINAL ROLES OF ATTACHMENT AND MATERNAL LANGUAGE.

Maternal mental state language is thought to influence children's mental state language and sociocognitive understanding (e.g., theory of mind), but the mechanism is unclear. The current study examined the longitudinal development of mental state language in mother-child interactions. The methodology included assessments of the child and/or mother-child dyad at six time points between 12 to 52 months of the child's age. Measures determined child's attachment style and language abilities, and mental state language used by mother and child during a block-building task. Results showed that (a) mental state talk, including belief and desire language, increased over time; (b) there were differences between the type of mental state words used by the mother in insecure versus secure dyads; (c) there were differences in patterns of mental state words used in both mothers and children in insecure versus secure dyads; and (d) attachment appeared to exert a consistent influence over time.

Decrease in Behavioral Problems and Trauma Symptoms Among At-Risk Adopted Children Following Web-Based Trauma-Informed Parent Training Intervention.

Children who have experienced early adversities are at risk for behavioral problems and trauma symptoms. Using a two-group, pre-post intervention design, the authors evaluated the effectiveness of an online parent training for Trust-Based Relational Intervention, a trauma-informed, attachment-based intervention, in reducing behavioral problems and trauma symptoms in at-risk adopted children. Children of parents in the treatment group (n = 48) demonstrated significant decreases in behavioral problems and trauma symptoms after intervention. Scores for children in a matched-sample control group did not change. Findings suggest this intervention can effectively reduce behavioral problems and trauma symptoms in children with histories of adversities.

Decrease in Behavioral Problems and Trauma Symptoms Among At-Risk Adopted Children Following Trauma-Informed Parent Training Intervention.

Children who have experienced early adversities are at risk for behavioral problems and trauma symptoms. Using a two-group, pre-post intervention design, the current study evaluated the effectiveness of a parent training utilizing Trust-Based Relational Intervention, a trauma-informed, attachment-based intervention, in reducing behavioral problems and trauma symptoms in at-risk adopted children. Children of parents in the treatment group (n = 48) demonstrated significant decreases in behavioral problems on the Strengths and Difficulties Questionnaire and significant decreases in trauma symptoms on the Trauma Symptoms Checklist for Young Children after intervention. Scores for children in a matched-sample control group did not change. Findings suggest that Trust-Based Relational Intervention is effective at addressing many behavioral problems and trauma symptoms in children with histories of adversities.

A spontaneous emergence of attachment behavior in at-risk children and a correlation with sensory deficits.

PROBLEM: Complex developmental trauma affects large numbers of children who have suffered from abuse, neglect, and/or deprivation. The effects often manifest in problems of attachment. METHODS: Researchers conducted therapeutic day camps for at-risk children to determine whether multimodal therapies could ameliorate the effects of complex developmental trauma. Two groups of adopted children (ages 3-9 and 10-14 years) with histories of trauma attended separate 3-week camps. FINDINGS: Data analysis indicated a positive correlation between negative attachment behaviors and deficits in sensory processing. Increased pro-attachment behaviors were found to have a significant relationship with pre-camp deficits in sensory processing. CONCLUSIONS: These results are discussed in the context of systems theory.

Severe punishment of children by staff in Romanian placement centers for school-aged children: effects of child and institutional characteristics.

The objective of this study was to determine whether children's characteristics and/or institutional characteristics were predictors of severe punishments (including beatings) and/or frequency of punishments that children received from staff in Romanian institutions. The data was hierarchical with institutionalized children (N=1391) nested within 44 institutions, and the measurement of punishments by the staff and frequency of punishments had a binary distribution. Thus, multilevel logistic regression models were used to examine the effects of individual and institutional level variables on reported punishments and to account for the clustering of the children within institutions. Two general patterns of results emerged. First, regarding individual level variables, it was found that: (1) amount of time spent by children in their current institutions had a significant effect on the probability of being punished by staff and the frequency of this punishment; (2) the probability of being punished was higher for boys than for girls; and (3) having no siblings in the institution increased the odds of being punished several times. Second, regarding institutional level variables: (4) being in placement centers for school-aged children with a traditional type of institutional organization increased the odds of severe punishment compared to a familial/mixed type. The results of the present study highlight the importance of understanding the consequences of institutionalization in a broader way, where children not only experienced early severe psychosocial deprivation as documented in other studies, but also high levels of severe punishments administered by institutional staff.

Trust-Based Relational Intervention (TBRI): A Systemic Approach to Complex Developmental Trauma.

Children and youth who have experienced foster care or orphanage-rearing have often experienced complex developmental trauma, demonstrating an interactive set of psychological and behavioral issues. Trust-Based Relational Intervention (TBRI) is a therapeutic model that trains caregivers to provide effective support and treatment for at-risk children. TBRI has been applied in orphanages, courts, residential treatment facilities, group homes, foster and adoptive homes, churches, and schools. It has been used effectively with children and youth of all ages and all risk levels. This article provides the research base for TBRI and examples of how it is applied.

Factors influencing mercury accumulation in three species of forage fish from Caddo Lake, Texas, USA.

Most studies that have examined mercury (Hg) contamination of fish have focused on game species feeding near the top of the food web, while studies that examine forage fish that feed near the base of the food web are rare. We conducted a survey of Hg contamination in three species of forage fish, brook silverside (Labidesthes sicculus), threadfin shad (Dorosoma petenense) and gizzard shad (Dorosoma cepedianum), from Caddo Lake, Texas, USA and found species-specific differences in Hg concentrations. We examined total length, age, trophic position (determined using delta15N), and growth rate of forage fish as factors that could have influenced within- and between-species differences in Hg concentration. Total length and age were the best predictors of within-species differences in Hg concentration. Between-species differences in Hg concentrations were most strongly influenced by trophic position.