Understanding and Addressing the Needs of Students in Special Education Through a Trauma-Informed Resilience Curriculum.

This school program evaluation aims to highlight the mental health needs of students in special education with behavioral and emotional challenges and describe the implementation of a resilience curriculum with this population. We evaluated district mental health data from a convenience sample of 814 students in grades 5-12 special education to identify risk for mental health symptoms, violence exposure, and substance use. School social workers provided feedback on the implementation of the resilience curriculum to inform program evaluation. Students reported significant risk for traumatic stress, anxiety, and depressive symptoms, and high rates of violence exposure and substance use. School social workers described adaptations to the resilience curriculum and gave recommendations for future implementation. Students receiving special education services for behavioral and emotional challenges had high mental health need, including high rates of violence exposure, and may benefit from a trauma-informed school-based resilience curriculum adapted for their needs.

Implementing depression care in under-resourced communities: a school-based family resilience skill-building pilot randomized controlled trial in the United States.

Introduction: Youth in under-resourced communities are more likely to have greater social risk factors for mental health needs yet have less access to needed care. School-based mental health services are effective in treating common disorders such as adolescent depression; however, few have a family-centered approach, which may especially benefit specific populations. Methods: Utilizing a community-partnered approach, we adapted an established, trauma-informed, resilience skill-building family intervention for adolescents with depression. We conducted a small randomized controlled feasibility pilot of an adapted intervention in a large school district that serves predominately low-income, Latinx students in the Southwest United States between 2014-2017. Youth between the ages of 12-18 years old with a Patient Health Questionnaire (PHQ-8) score of 10 or higher, who spoke English or Spanish, were recruited from 12 school mental health clinics. Twenty-five eligible adolescents with depression and their participating caregivers were enrolled and randomly assigned to receive either the adapted intervention, Families OverComing Under Stress for Families with Adolescent Depression (FOCUS-AD), or usual care, Cognitive Behavioral Therapy (CBT) only. Most of the sample was Latinx and female. We evaluated feasibility, acceptability, and preliminary effectiveness. Results: Among participants who completed standardized assessments administered at baseline and approximately five months post-randomization (n = 10 FOCUS-AD, n = 11 CBT only), effectiveness was explored by identifying significant changes over time in adolescent mental health within the FOCUS-AD and CBT only groups and comparing the magnitude of these changes between groups. Nonparametric statistical tests were used. We found the FOCUS-AD intervention to be feasible and acceptable; participant retention was high. Adolescent symptoms of depression (measured by the PHQ-8) improved significantly from baseline to follow-up for youth in both FOCUS-AD (median decrease [MD] = 10, p = 0.02) and control (MD = 6, p = 0.01) groups, with no significant difference across the two groups. Results were similar for symptoms of PTSD (measured by the Child PTSD Symptom Scale; FOCUS-AD MD = 12.5, p = 0.01; CBT only MD = 7, p = 0.04; no significant difference between groups). Conclusion: Family-centered approaches to depression treatment among adolescents living in under-resourced communities may lead to improved mental health, although further research is warranted.

Implementing a School-Based, Trauma-Informed Resilience Curriculum for Parents.

"Families OverComing Under Stress" (FOCUS) Resilience Curriculum for Parents (FRC-P) is a trauma-informed group parenting program adapted for school social workers to deliver to parents of racial/ethnic minority urban public schoolchildren, an under-researched group of parents in the literature. The objective was to describe implementation of the pilot FRC-P in terms of possible effectiveness, feasibility, and acceptability. Social workers delivered FRC-P to parents at 16 schools. We analyzed (1) changes in parent well-being; (2) parent satisfaction; and (3) a focus group of participating social workers. Ninety-six of 261 parents (37%) who attended FRC-P completed pre and post surveys. Parents reported significant improvements (p < .01) in family functioning (Cohen's d = 0.41), parent connectedness (d = 0.71), and social support (d = 0.66). Social workers linked parents to needed services. Parents and social workers found FRC-P feasible and acceptable. With refinement, FRC-P could help schools foster resilience in under-resourced parents.

Adapting and Implementing a School-Based Resilience-Building Curriculum Among Low-Income Racial and Ethnic Minority Students.

Although youth are at risk for exposure to adversity and trauma, many youth, especially ethnic and racial minorities, do not have access to mental health care. Resilience-building curriculums can teach important internal resilience skills and provide support to students who may not receive prevention or treatment services. We adapted a resilience curriculum initially used for military-connected youth facing adversities related to parental wartime deployments, to meet the needs of low-income, predominantly racial and ethnic minority students in a large urban school district. In this article we describe the cultural adaptation, the implementation process, and the evaluation of the trauma-informed resilience curriculum using pre-post surveys and focus group discussions. We found significantly improved overall internal resilience scores, as well as significantly improved scores on subscales of problem solving and empathy among students receiving the curriculum. The focus groups revealed that the curriculum enhanced connections among students, as well as students and teachers, and served as a way to destigmatize mental health issues. The acceptability of the curriculum, as well as implementation successes and challenges are described. We provide suggestions for future steps for school psychologists and school social workers for implementing this curriculum.

The Impact of Specific and Complex Trauma on the Mental Health of Homeless Youth.

This study investigates the relative impact of trauma experiences that occurred prior to and since becoming homeless on depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and self-injurious behaviors among a sample of homeless youth (N = 389). Youth (aged 13 to 25) who had been homeless or precariously housed in the past year completed a survey about housing history, experiences of violence and victimization, mental health, and service utilization. In addition to examining the impact associated with specific trauma types, we also considered the effect of "early-on" poly-victimization (i.e., cumulative number of reported traumas prior to homelessness) and the influence of a compound sexual trauma variable created to represent earlier complex trauma. This created-variable has values ranging from no reported trauma, single trauma, multiple non-sexual traumas, and multiple traumas that co-occurred with sexual abuse. Multivariate analyses revealed that specific traumatic experiences prior to homelessness, including sexual abuse, emotional abuse/neglect, and adverse home environment, predicted greater mental health symptoms. Poly-victimization did not add to the prediction of mental health symptoms after the inclusion of specific traumas. Results with early compound sexual trauma revealed significant differences between lower-order trauma exposures and multiple-trauma exposures. Specifically, experience of multiple traumas that co-occurred with sexual trauma was significantly more detrimental in predicting PTSD symptoms than multiple traumas of non-sexual nature. Findings support the utility of an alternate/novel conceptualization of complex trauma, and support the need to carefully evaluate complex traumatic experiences that occurred prior to homelessness, which can impact the design and implementation of mental health care and services for homeless youth.