Application of the Toxic Stress Schema: An Exemplar for School Nurses.

For many children of color, the cumulative impact of pre-existing stressors, disparities, and pandemic-related losses has contributed to a toxic level of stress. Toxic stress can disrupt healthy brain development making children vulnerable to physical and mental health problems. School nurses are the primary health professionals who interact with children daily during the academic year, which positions them to identify risk factors within the social determinants of health that contribute to the development of toxic stress. The Toxic Stress Schema (TSS) provides a framework for assessment and care planning related to social determinants of health and potential sources of stress and/or buffering support for the physical and mental well-being of children. A case study approach is used to demonstrate the application of the TSS to school nursing and provide the basis for conceptualizing a plan of care and identifying resources to support the child's physical and mental health.

A Schema of Toxic Stress Informed by Racism, Transgenerational Stress, and Disadvantage.

INTRODUCTION: The Toxic Stress Schema (TSS) is an ecological framework with a social justice lens for identifying and alleviating stress and strengthening social determinants of health for children and families of color impacted by the COVID-19 pandemic and the cumulative effects of racism and generational, systemic inequities. METHOD: Relevant literature is reviewed, and examples were provided to illustrate the differential impacts of the "stress superstorm" of 2020 had on children of color based on their family's position on the advantage-disadvantage continuum. RESULTS: The utility of the TSS framework as a model for advanced nursing practice is demonstrated, and recommendations are formulated for the pediatric nurse practitioner's role in health policy. DISCUSSION: The COVID-19 pandemic elucidated the historical inequities experienced by children and families of color. The TSS framework provides a model for recognizing, organizing, and implementing.

Trauma proliferation and stress generation (TPSG) dynamics and their implications for clinical science.

The current research and clinical focus on single traumas fails to assess numerous important trauma dynamics including trauma proliferation. In this study, 2 trauma proliferation pathways were identified that utilize a developmentally based trauma framework (DBTF). Data previously collected from 6 different cultural groups (N = 2279; 2 mental health clinics in Egypt and the United States, Native Americans, Palestinian adults in Gaza, and college students in Poland and Egypt) were reanalyzed. The 6 studies utilized DBTF-based measures of cumulative trauma and trauma types. Path analysis was used to test the trauma proliferation model and PROCESS software was used to identify mediators and their effect sizes. Results of the analyses indicated that attachment trauma and collective identity trauma independently predicted (directly and through mediators) personal identity trauma, role identity trauma, secondary trauma, and survival trauma. The pattern of proliferation was configurally invariant across the 6 groups and strictly invariant across genders. Implications for the consideration of trauma global dynamics, such as trauma proliferation, are discussed. (PsycINFO Database Record

Psychometric assessment of the Arabic version of the Internalized Stigma of Mental Illness (ISMI) measure in a refugee population.

The study explored the psychometric properties of the Arabic version of the ISMI measure on an Arab sub-sample (N = 330) in a health clinic that served mostly refugees in Michigan, USA. Study measures included the ISMI, PTSD, depression, anxiety, CTD (Cumulative Trauma Disorders), and traumatic stress measures. Data analysis included factor analysis, correlation, and multiple regression analysis. The Arabic form of the measure was found to have robust psychometric qualities, with high reliability construct and predictive validity. Factor analysis identified a general stigma factor and different levels of stigma resistance factors. General stigma was significantly associated with and predicted post-trauma symptoms of depression, anxiety, PTSD and CTD (complex PTSD), while tough stigma resistance was associated negatively with PTSD and depression and positively with positive appraisal of traumatic events.

Violence exposure and teen dating violence among African American youth.

This study examines the relationships between exposure to violence in the community, school, and family with dating violence attitudes and behaviors among 175 urban African American youth. Age, gender, state support and experiences with neglect, school violence, and community violence were the most significant predictors of acceptance of dating violence. Experiences with community violence and age were important predictors of dating violence perpetration and victimization. Findings highlight the importance of planning prevention programs that address variables affecting attitudes and behaviors of high-risk youth who have already been exposed to multiple types of violence.

The Traumatogenic Dynamics of Internalized Stigma of Mental Illness Among Arab American, Muslim, and Refugee Clients.

Understanding the dynamics of mental health stigma through existing frameworks, especially in minorities with higher stigma, is problematic. There is a need to reconceptualize stigma, particularly in highly traumatized groups. The current study examines the validity of a new development-based trauma framework that conceptualizes stigma as a type III chronic trauma that contributes to negative mental health effects. This framework proposes that public stigma is a unique chronic traumatic stress that mediates the effects of similar trauma types in mental health patients. To test this proposition, this study explores the relationships between internalized stigma of mental illness (ISMI), different trauma types, and posttrauma spectrum disorders. ISMI, posttraumatic stress disorder, other posttrauma spectrum disorders, and cumulative trauma measures were administered to a sample of 399 mental health patients that included Arab (82%), Muslim (84%), and refugee (31%), as well as American patients (18%). Age in the sample ranged from 18 to 76 years (M = 39.66, SD = 11.45), with 53.5% males. Hierarchical multiple regression, t tests, and path analyses were conducted. Results indicated that ISMI predicted posttraumatic stress disorder and other posttrauma spectrum disorders after controlling for cumulative trauma. ISMI was associated with other chronic collective identity traumas. While Arab Americans, Muslims, and refugees had higher ISMI scores than other Americans, the elevated chronic trauma levels of these groups were significant predictors of these differences. The results provide evidence to support ISMI traumatology model. Implications of the results for treating victims of ISMI, especially Arab Americans, Muslims and refugees are discussed.

Iraqi American refugee youths' exposure to violence: relationship to attitudes and peers' perpetration of dating violence.

This exploratory study examines the relationships between exposure to violence in the community, school, home and dating relationships among Iraqi American youth. As Iraqi American youth are traditionally not allowed to date, dating violence measures focused on attitudes about and perceptions of abuse occurring in the relationships of friends. The number of friends known who were secretly dating was the most significant predictor of acceptability of dating violence and perceived prevalence of abuse. Youth who experienced child abuse perceived higher rates of dating violence among their peers. Findings highlight the complexities of prevention and intervention of teen dating violence within secretive relationships.

Examining the effectiveness of 2 solutions used to flush capped pediatric peripheral intravenous catheters.

An evidence-based study examined the effectiveness of 2 solutions, heparin and normal saline, when used to flush capped pediatric peripheral intravenous (CPP IV) catheters. This experimental study assessed patency, redness, swelling, clotting, bruising, leakage, and patient pain after each intervention/flush. Study participants included 62 children (32 heparin and 30 normal saline) who had CPP IV catheters using 20-, 22-, or 24-gauge catheters. No statistically significant differences were found in IV catheter patency between children in the normal saline group and children in the heparin group. A postimplementation follow-up study with 30 patients who received normal saline only as a flush experienced no patency issues.

The effects of gender discrimination on refugee torture survivors: a cross-cultural traumatology perspective.

Trauma developmental theory identifies gender discrimination (GD) as a type of persistent, ongoing trauma that has the potential for serious, negative effects on mental health. This study was conducted to examine the potential role of GD in the development of cumulative trauma disorders (CTD) and symptoms of posttraumatic stress disorder (PTSD) as well as the role of GD in mediating the effects of other traumas on these disorders. The sample included 160 female torture survivors from more than 30 countries. Measures of PTSD, CTD, and types of trauma exposure were acquired as part of a larger study on refugee torture survivors. Structural equation modeling was used to test several plausible models for the direct and indirect effects of GD on PTSD and CTD, within the context of other trauma exposure. Results suggest that GD mediates the effects of identity traumas on CTD and PTSD. GD also had direct effects on CTD, including relationships with dissociation, suicidality, and deficits in executive function. GD did not appear to directly influence the development of PTSD. The implications of these results for assessment and treatment of women's trauma-related disorders as well as strategies for their prevention are discussed.

Improving healthcare and outcomes for high-risk children and teens: formation of the National Consortium for Pediatric and Adolescent Evidence-Based Practice.

Although major healthcare and professional organizations as well as key leaders have long emphasized the importance of evidence-based practice (EBP) in improving patient care and outcomes, the majority of healthcare professionals do not implement EBP. There is a huge gap in time that exists between the generation of research findings and the translation of those findings into clinical practice. Many efficacious interventions are not being used in clinical practice even though research findings suggest that they improve child and adolescent health and development. Conversely, many clinical practices are being implemented without sufficient evidence to support their use. Because of the need to accelerate EBP and to generate evidence to support best practices, the first EBP Leadership Summit focused on children and adolescents was conducted in February 2007. Several nationally recognized EBP experts and healthcare leaders from a number of children's hospitals and colleges of nursing across the U.S. participated in the Summit. This article describes the process used and outcomes generated from this landmark event in child and adolescent healthcare, including the launching of the new National Consortium for Pediatric and Adolescent EBP (NCPAEP). Future directions of the consortium also are highlighted.