Examining the Relation Between Early Violence Exposure and Firearm-Related Experiences in Emerging Adulthood: A Longitudinal Cohort Study.

Firearms are a leading cause of death among adolescents and young adults in the United States. Early exposure to violence, as a victim or witness, is associated with increased risk of firearm-related experiences, including carrying and threatening others with a gun. These experiences, in turn, increase the risk of both fatal and non-fatal firearm injuries. Using an ethnically diverse sample of emerging adults, we build on prior research by examining the link between early violence exposure at multiple contexts of the social-ecological model and multiple firearm-related experiences (i.e., firearm-threatening victimization, firearm-threatening perpetration, and firearm carriage). We analyzed data from a 10-year longitudinal study of 1042 youth in the Southern United States. Experiencing childhood physical abuse was associated with both firearm-threatening victimization and perpetration in emerging adulthood. Additionally, exposure to neighborhood and interparental violence were linked to threatening others with firearms and carrying firearms, respectively. Counter to expectations, bullying victimization did not emerge as a predictor of any firearm-related experiences. Findings highlight the importance of cross-cutting violence prevention efforts to prevent high-risk firearm-related behaviors among emerging adults. Programs for children and adolescents that address these types of violence exposure should highlight coping skills and sources of positive social support to bolster protective factors against firearm-related outcomes.

Firearm screening and secure storage counseling among home visiting providers: a cross-sectional study of SafeCare® providers in the U.S.

Background: Firearms used in pediatric firearm deaths are most often obtained from the child's home, making secure firearm storage initiatives imperative in prevention efforts. Evidence-based home visiting (EBHV) programs are implemented with over 277,000 families annually, providing an opportunity for secure firearm storage counseling. The purpose of this study was to assess EBHV providers' experiences with firearm screening ("assessment"), secure storage counseling, and their perceptions for related training needs. Methods: Providers in the U.S. from SafeCare®, an EBHV program often implemented with families experiencing increased risk of child neglect and physical or emotional abuse, were invited to participate in a survey to examine firearm assessment and attitudes toward and experiences with firearm safety counseling. Survey items were primarily Likert scale ratings to indicate level of agreement, with some open-ended follow-up questions. Descriptive statistics (i.e., frequencies and percentages) were used to report item-level agreement. A post hoc analysis was conducted using Spearman correlation to examine the association between assessment and counseling and provider-level factors. Results: Sixty-three SafeCare providers consented to and completed the survey items. Almost three-quarters (74.6%) agreed/strongly agreed that they assess in-home firearm availability. However, 66.7% agreed/strongly agreed that they have not been adequately trained to discuss firearm safety topics. A substantial proportion (80.6%) indicated they would counsel more if materials and training on this topic were available. Response variability emerged by level of urbanicity. A post hoc analysis found that providers' self-reported frequency of assessment and counseling were associated with their comfort level discussing firearm safety and whether or not they had worked with families impacted by firearm injury. Conclusion: SafeCare providers report a need for materials and training on secure firearm storage, and a willingness to provide more counseling with proper training to the families they serve. Findings illuminate the need for secure storage initiatives for EBHV programs, which have broad service reach to a substantial number of at-risk U.S. families annually.

The PTSD Symptom Presentation and the Effect of Polytrauma on PTSD Symptom Clusters Among Young People Who Have Experienced Commercial Sexual Exploitation and Trafficking.

Purpose: The purpose of this study was to describe the PTSD symptom presentation (including dissociative symptoms) of PTSD using the Diagnostic and Statistical Manual of Mental Disorders 5 th Edition diagnostic criteria and explore associations between the symptom severity for each of the four PTSD symptom clusters and polytrauma, defined as multiple exposures to different categories of potentially traumatic events. Methods: This is a secondary analysis of cross-sectional program evaluation data among 95 young people (aged 11-19) at therapy initiation in a southeastern state in the U.S. We used descriptive statistics and multivariable linear regression to test study objectives. Results: Eighty-one respondents (90.0%) experienced a potentially traumatic event in ≥ 2 trauma categories, in addition to experiencing CSE/T. Approximately two-thirds of respondents experienced clinically significant PTSD symptoms for each symptom cluster. Of the 31 young people who met full criteria for PTSD, 9 met criteria for the standard PTSD diagnosis, while 22 met criteria for the dissociative subtype of PTSD. On average, experiencing additional trauma categories was associated with substantively higher PTSD symptom cluster scores for each cluster. Conclusions: These findings support the need for a comprehensive assessment of trauma symptoms that includes cluster-specific PTSD symptoms. They also underscore the need to assess the full breadth and chronicity of trauma experiences to guide treatment planning and delivery, targeting specific domains of trauma impact. These findings can also inform the tailoring and adaptation of evidence-based interventions and strategies to better meet the needs of young people who have experienced CSE/T.

Methodological Challenge: Addressing Bots in Online Research.

Internet-based research has become useful for data collection, particularly because it reduces the time and resources required for recruitment. Although participant recruitment using social media is a scientifically and ethically sound methodology for many studies, this approach attracts fraudulent participants and Internet bots which can pose serious threats to sample validity and data integrity. We present several case examples of research studies in which bots were encountered and the procedures used to address them. In addition, we provide an overview of strategies researchers can use to mitigate the risks associated with Internet-based recruitment methods.

Posttraumatic Cognitions and Posttraumatic Stress Symptoms Among Young People Who Have Experienced Commercial Sexual Exploitation and Trafficking.

OBJECTIVES: The impact of posttraumatic cognitions on the development and maintenance of posttraumatic stress symptoms (PTSS) is understudied among children and adolescents who have experienced commercial sexual exploitation/trafficking (CSE/T). The objectives of this study were to (1) explore posttraumatic cognitions among help-seeking young people aged 11-19 who have experienced CSE/T; (2) determine whether experiencing direct violence, witnessing violence, polyvictimization (ie, multiple exposures to different categories of potentially traumatic events), or demographic characteristics differentially affect whether these young people meet clinical criteria for posttraumatic cognitions using established cutoffs; and (3) explore associations between posttraumatic cognitions and PTSS among young people who have experienced CSE/T. METHODS: This study is a secondary analysis of a baseline cross-sectional survey of 110 young people with substantiated CSE/T experiences who started trauma-focused cognitive behavioral therapy (mean [SD] age = 15.8 [1.5]) from August 1, 2013, through March 31, 2020, in a southeastern US state. We used descriptive statistics, adjusted modified Poisson regression, and adjusted linear regression to test study objectives. RESULTS: Fifty-seven of 110 (51.8%) young people aged 11-19 met clinical criteria for posttraumatic cognitions. Increased age and a greater number of trauma categories experienced were significantly associated with meeting clinical criteria for posttraumatic cognitions. On average, higher posttraumatic cognition scores were associated with higher PTSS scores, controlling for demographic characteristics (ß = 0.95; 95% CI, 0.64-1.26). CONCLUSIONS: These findings underscore the importance of assessing comprehensive trauma history and PTSS of young people who have experienced CSE/T, with added usefulness of measuring cognitive appraisals to inform a therapeutic treatment plan. Measuring cognitive appraisals that may influence PTSS and therapeutic success can ensure an effective public health response for this population.

The Impact of COVID-19 on the Delivery of an Evidence-Based Child Maltreatment Prevention Program: Understanding the Perspectives of SafeCare® Providers.

Child maltreatment (CM) is a global public health problem. Evidence-based home visiting programs, such as SafeCare®, reduce CM risk, and enhance parent-child relationships and other protective factors. As the result of the COVID-19 pandemic and resulting restrictions, SafeCare Providers transitioned from home to virtual delivery for the SafeCare curriculum. The purpose of this study is to 1) examine active SafeCare Providers' opinions on the feasibility and effectiveness of SafeCare via remote delivery, and 2) better understand workforce concerns for human service professionals within the context of COVID-19 mitigation efforts. Data are from a cross-sectional survey of SafeCare Providers (N = 303) in the United States, Canada, and Australia. The majority of Providers reported they were actively delivering SafeCare virtually and were comfortable with the delivery format. Providers indicated that the majority of SafeCare families are making progress on target skills, and that engagement is high among many families. Some service delivery challenges were reported, ranging from family data plan limitations to difficulty with delivery of specific components of the SafeCare curriculum related to modeling and assessment. The impact of COVID-19 on Providers' daily routines, stress level, and work-life balance has been significant. Remote, virtual delivery of CM prevention programming offers the opportunity to continue serving vulnerable families in the midst of a pandemic. Barriers related to family technology and data access must be addressed to ensure reach and the effective delivery of prevention programming during the pandemic and beyond.

Exploring the Impact of Trauma History on the Mental Health Presentations of Youth who have Experienced Commercial Sexual Exploitation and Trafficking.

This study explores the types and extent of potentially traumatic events that youth who have experienced commercial sexual exploitation and trafficking (CSE/T) report, and how these experiences influence mental health. CSE/T youth (N = 110, 11-19 years old) referred to Trauma-Focused Cognitive Behavioral therapists affiliated with Project Intersect provided self-report data between August 2013 and March 2020 at the start (baseline), mid-point, and completion of therapeutic services. This study focuses on the baseline data collected. Bivariate relationships were analyzed, and where bivariate associations were statistically significant, associations were assessed in adjusted regression models. Two logistic regressions were performed: one for the adjusted associations between types of potentially traumatic events reported by CSE/T youth and the outcome PTSD, and a second for the outcome emotional distress. Results indicated that polytrauma was significantly associated with PTSD diagnosis among CSE/T youth. Direct violence victimization and polytrauma were significantly associated with CSE/T youth emotional distress. Results inform behavioral medicine practitioner considerations for how to appropriately assess the potentially traumatic experiences of CSE/T youth, and how these experiences may differentially impact the mental health presentations of youth in clinical treatment. Effective treatment may include precision-based customization of evidence-based practices to ensure that the diverse traumatic experiences and related symptomatology of CSE/T youth are effectively addressed.

Child maltreatment, suicidal ideation, and in-home firearm availability in the U.S.: findings from the longitudinal studies of child abuse and neglect.

Suicide is the second leading cause of death among adolescents in the U.S., and risk factors include child maltreatment (CM), especially physical and emotional abuse, and in-home firearm availability ('availability'). However, research examining availability among adolescent populations at-risk for CM is limited. This study examines availability in this population, the association between CM and availability, and availability among adolescents experiencing suicidal ideation. A multivariable modified Poisson regression model assessed the relationship between CM by age 12 and availability at age 14 using data from the Longitudinal Studies of Child Abuse and Neglect (n = 1,354 families). Approximately 11.61% of adolescents reported availability, and physical abuse increased the risk of availability (aRR = 1.94; 95% CI [1.22, 3.08]). Over one-quarter (27.50%) of adolescents with suicidal ideation at age 16 reported availability. Child welfare-involved families are often referred to interventions. Future research and prevention efforts should explore augmentation of these programmes with firearm safe storage guidance.

Associations Among Age of First Experience of Violence, Type of Victimization, Polyvictimization, and Mental Distress in Nigerian Females.

This study explored associations of age of first victimization, sexual violence (SV), physical violence (PV), polyvictimization, and mental distress among females in Nigeria (n = 1,766, 13-24 years old) using the nationally representative 2014 Nigeria Violence Against Children Survey. Multinomial logistic regressions were performed. Nigerian females reporting SV victimization and polyvictimization were more likely to experience higher mental distress. The older the female was at the time of PV victimization, the greater the risk for mental distress. Violence is prevalent in Nigeria and its impact on youth's health is severe. However, evidence-based and data-driven policies and programs can reduce and prevent violence.

Parent and Child Reports of Parenting Behaviors: Agreement Among a Longitudinal Study of Drug Court Participants.

Identifying ways to support children of parents with substance use disorder is a critical public health issue. This study focused on the parent-child relationship as a critical catalyst in child resilience. Using data from a longitudinal cohort study, the aims of this study were to: (1 ) examine the agreement between parent and child reports of parenting behaviors and (2 ) describe the association between agreement and child mental health. Participants were 50 parent-child dyads that included parents enrolled in an adult drug court and their children, aged 8-18. Overall, agreement (i.e., concordance) between parent and child reports of parenting was slight to fair. Parents reported their parenting behaviors to be slightly more positive than how children rated the same behaviors in the areas of: involvement, 0.53 (SD = 0.80); positive parenting, 0.66 (SD = 0.87), and monitoring behaviors, 0.46 (SD = 0.90). Parents also rated themselves, in comparison to their children's reports, as using less inconsistent discipline, -0.33 (SD = 1.00), and less corporal punishment, 0.13 (SD = 1.01). Agreement was related to some, but not all, child mental health outcomes. When parents rating their parenting as more positive than their child reported, that had a negative effect on child self-esteem and personal adjustment. Contrary to hypotheses, we did not find a significant relationship between positive parenting and internalizing problems. Findings have implications for obtaining parent and child reports of parenting within the drug court system, and for identifying children at higher risk for externalizing problems.

Substance use and deaths by suicide: A latent class analysis of the National Violent Death Reporting System.

Substance use is strongly associated with suicide completions. However, little is known about the patterns of substances used in suicide deaths. The purpose of this analysis is to determine latent classes of toxicology-reported substances among individuals who completed suicide. The sample consists of suicide victims in the National Violent Death Reporting System (NVDRS) during years 2003-2017 (n = 202,838). Toxicology reports were used to construct latent class analyses of substance use among suicide victims. Correlates for latent class membership included sex, race/ethnicity, previous experiences of child abuse, homelessness, and intimate partner violence (IPV) victimization. The majority of suicide victims were male (77.7%), straight/heterosexual (99.5%) and white (88.3%). The final unconditional model yielded a four-class model, including a "No substance/single substance use" class, an "Alcohol and other substance" class, a "Marijuana and other substance" class, and an "Opiate use" class. Compared to the reference class of "No substance/single substance," females were more likely than males to be classified in the "Alcohol and other substance" class, the "Multi-substance use" class, and the "Opiate use" class. Homelessness was associated with classification in the "Marijuana and other substance" class and the "Opiate use" class compared to the "No substance/single substance" class. IPV was associated with both polysubstance use classes ("Alcohol plus other substance" and "Marijuana plus other substance") along with the "Opiate use" class compared to the "No substance/single substance" class. These classes highlight profiles of suicide descendants and emphasize the importance of polysubstance use prevention among females, homeless individuals, and those who experience IPV.

T-cell Activation Is Correlated With Monocyte Activation in HCV/HIV Coinfection and Declines During HCV Direct-Acting Antiviral Therapy.

BACKGROUND: Immune activation markers associate with morbidity and mortality in HIV and hepatitis C virus (HCV) infection. We investigated how T-cell and monocyte activation are related over the course of HCV direct-acting antiviral (DAA) therapy during HCV/HIV coinfection. METHODS: Peripheral blood mononuclear cells from AIDS Clinical Trials Group (ACTG) A5329 participants and a single-site separate cohort treated with DAAs were analyzed for central memory (CM)/effector memory (EM) T-cell subsets, monocyte subsets, and cell activation (CD38 and HLA-DR expression) before, during, and after therapy. RESULTS: Before therapy, classical and inflammatory monocyte subset HLA-DR expression positively correlated with absolute counts and frequencies of CD38+HLA-DR+-expressing CD4+ and CD8 T cells and corresponding CM and EM subsets. After therapy initiation, CD38+HLA-DR+ co-expression on CD4+ and CD8+ memory T cells decreased by 12 weeks and 36 weeks, and plasma sCD14 positively correlated with CD38+HLA-DR+ CD4+ and CD4+CM T-cell frequencies. Monocyte subset activation remained similar over time. CONCLUSIONS: During HCV/HIV coinfection, memory T-cell activation is associated with monocyte subset activation, consistent with related underlying mechanisms. Following therapy initiation, memory T-cell, but not monocyte, activation decreased. Residual CD4+ T-cell activation after therapy completion is associated with sCD14, potentially linking the remaining CD4+ T-cell activation to residual factors driving activation in antiretroviral therapy-controlled HIV.

Digital Tools to Support Family-Based Weight Management for Children: Mixed Methods Pilot and Feasibility Study.

BACKGROUND: Family-based behavioral therapy is an efficacious approach to deliver weight management counseling to children and their parents. However, most families do not have access to in-person, evidence-based treatment. We previously developed and tested DRIVE (Developing Relationships that Include Values of Eating and Exercise), a home-based parent training program to maintain body weight among children at risk for obesity, with the intent to eventually disseminate it nationally alongside SafeCare, a parent support program that focuses on parent-child interactions. Currently the DRIVE program has only been tested independently of SafeCare. This study created the "mHealth DRIVE" program by further adapting DRIVE to incorporate digital and mobile health tools, including remotely delivered sessions, a wireless scale that enabled a child-tailored weight graph, and a pedometer. Telehealth delivery via mHealth platforms and other digital tools can improve program cost-effectiveness, deliver long-term care, and directly support both families and care providers. OBJECTIVE: The objective of this study was to examine preliminary acceptability and effectiveness of the mHealth DRIVE program among children and parents who received it and among SafeCare providers who potentially could deliver it. METHODS: Study 1 was a 13-week pilot study of a remotely delivered mHealth family-based weight management program. Satisfaction surveys were administered, and height and weight were measured pre- and post-study. Study 2 was a feasibility/acceptability survey administered to SafeCare providers. RESULTS: Parental and child satisfaction (mean of 4.9/6.0 and 3.8/5.0, respectively) were high, and children's (N=10) BMI z-scores significantly decreased (mean -0.14, SD 0.17; P=.025). Over 90% of SafeCare providers (N=74) indicated that SafeCare families would benefit from learning how to eat healthily and be more active, and 80% of providers reported that they and the families would benefit from digital tools to support child weight management. CONCLUSIONS: Pediatric mHealth weight management interventions show promise for effectiveness and acceptability by families and providers. TRIAL REGISTRATION: Clinicaltrials.gov NCT03297541, https://clinicaltrials.gov/ct2/show/NCT03297541.

Effect of the SafeCare© intervention on parenting outcomes among parents in child welfare systems: A cluster randomized trial.

Child maltreatment has long-lasting negative impacts, and interventions are needed to improve caregiver's parenting skills to prevent maltreatment. This paper reports on a randomized trial comparing the SafeCare© model to services as usual (SAU) for child-welfare referred caregivers. SafeCare is an 18-session behavioral parenting program that teaches skills in positive parent-child interactions, home safety, and child health. SAU is generally unstructured and includes support, crisis management, referrals for need, and parenting education. Teams of providers at nine sites were randomized to implement SafeCare (19 teams; 119 providers) or continue SAU (17 teams; 118 providers). Two-hundred eighty eight caregivers (193 SafeCare; 95 SAU) with children aged 0-5 who were receiving services agreed to complete a baseline and 6-month assessment. Assessments measured positive parenting behaviors, parenting stress, protective factors, and neglectful behaviors using validated scales. Participants were primarily white (74.6%), female (87.0%), and low-income (68.6%), and had a mean age of 29. Latent change score models (LCSM) using a sandwich estimator consistent with the trial design were used to examine changes in 13 outcomes. Results indicated that SafeCare had small to medium effects for improving several parenting outcomes including supporting positive child behaviors (d = 0.46), proactive parenting (d = 0.25), and two aspects of parenting stress (d = 0.28 and .30). No differential change between groups was found for other indicators, including all indicators of neglect. Parenting programs such as SafeCare offer a promising mode of intervention for child welfare systems. Scale-up of parenting programs can improve parenting, improve child outcomes, and potentially reduce maltreatment. CLINICALTRIAL.GOV REGISTRATION NUMBER: NCT02549287.

CDC Recommendations for Hepatitis C Screening Among Adults - United States, 2020.

Hepatitis C virus (HCV) infection is a major source of morbidity and mortality in the United States. HCV is transmitted primarily through parenteral exposures to infectious blood or body fluids that contain blood, most commonly through injection drug use. No vaccine against hepatitis C exists and no effective pre- or postexposure prophylaxis is available. More than half of persons who become infected with HCV will develop chronic infection. Direct-acting antiviral treatment can result in a virologic cure in most persons with 8-12 weeks of all-oral medication regimens. This report augments (i.e., updates and summarizes) previously published recommendations from CDC regarding testing for HCV infection in the United States (Smith BD, Morgan RL, Beckett GA, et al. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recomm Rec 2012;61[No. RR-4]). CDC is augmenting previous guidance with two new recommendations: 1) hepatitis C screening at least once in a lifetime for all adults aged ≥18 years, except in settings where the prevalence of HCV infection is <0.1% and 2) hepatitis C screening for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection is <0.1%. The recommendation for HCV testing that remains unchanged is regardless of age or setting prevalence, all persons with risk factors should be tested for hepatitis C, with periodic testing while risk factors persist. Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risks.

Violence victimization and negative health correlates of youth in post-earthquake Haiti: Findings from the cross-sectional violence against children survey.

BACKGROUND: We examined the prevalence of and relationships between violence victimization and negative health correlates of Haitian youth exposed to the 2010 earthquake. METHODS: Participants were randomly selected 13-24 year-old youth (1457 females; 1459 males) living in Haiti following the 2010 earthquake. Data collected via Haiti's 2012 Violence against Children Survey (VACS) were analyzed. RESULTS: Participants reported violence victimization in the past 12 months (females: 49.93%; males: 41.68%), moderate-to-severe mental distress (females: 76.56%; males: 66.41%), and suicidal ideation (females: 26.79%; males: 8.05%). Compared to participants without experiences of violence, victims of violence had significantly higher mean number of sexual partners (females: 1.99, 95% CI: 1.81-2.16, p = .02; males: 4.33, 95% CI: 3.50-5.16, p = .03), mental distress (females: 80.39%, p = .01; males: 72.95%, p = .002), and suicidal ideation (females: 36.09%, p < .0001; males: 12.02%, p < .0001). Male victims of violence were more likely to have sex without a condom (26.02%, p = .01) and female victims of violence were more likely to report histories of STIs (28.04%, p = .01), when compared to participants without history of violence. LIMITATIONS: Data were collected via self-report. Disaster exposure experiences were not assessed. Analysis was correlational and did not control for potential confounding variables. CONCLUSIONS: Disaster-exposed youth endorsed high levels of violence victimization and negative health correlates. Earthquake survivors who experienced violence were more likely to report negative health correlates. Greater attention to downstream sequelae of natural disasters is needed.

Who Gets the Benefit of the Doubt? Performance Evaluations, Medical Errors, and the Production of Gender Inequality in Emergency Medical Education.

Why do women continue to face barriers to success in professions, especially male-dominated ones, despite often outperforming men in similar subjects during schooling? With this study, we draw on role expectations theory to understand how inequality in assessment emerges as individuals transition from student to professional roles. To do this, we leverage the case of medical residency so that we can examine how changes in role expectations shape assessment while holding occupation and organization constant. By analyzing a dataset of 2,765 performance evaluations from a three-year emergency medicine training program, we empirically demonstrate that women and men are reviewed as equally capable at the beginning of residency, when the student role dominates; however, in year three, when the colleague role dominates, men are perceived as outperforming women. Furthermore, when we hold resident performance somewhat constant by comparing feedback to medical errors of similar severity, we find that in the third year of residency, but not the first, women receive more harsh criticism and less supportive feedback than men. Ultimately, this study suggests that role expectations, and the implicit biases they can trigger, matter significantly to the production of gender inequality, even when holding organization, occupation, and resident performance constant.

Featured counter-trafficking program: Project intersect.

This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children. Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research. This article describes Project Intersect, a program of mental health services and behavioral health professional training designed to address trauma-related psychological and behavioral problems experienced by adolescent survivors of commercial sexual exploitation and trafficking. The project is led by the Georgia Center for Child Advocacy in Atlanta, GA, USA. The primary goal of the program is to build a cadre of behavioral health specialists with skills to implement trauma-focused cognitive behavioral therapy to address the unique needs of trafficked/exploited youth. This involves intensive initial training, follow-up consultation, technical support, and program evaluation.

The impact of SafeCare® Dads to Kids program on father maltreatment risk and involvement: Outcomes and lessons learned from an efficacy trial.

Child Maltreatment (CM) is a public health problem, and experts recommend parent training programs as a prevention method. Few programs target fathers, even though male caregivers are involved as perpetrators in approximately 45% of substantiated CM cases. This study examines the efficacy of an adapted version of SafeCare (Dad2K) with marginalized fathers. Participants include a convenience sample of fathers with children ages 2-5 years. Fathers (n=99) were randomized to an 1) intervention group (SafeCare Dad2K) or to a 2) comparison group (receiving parenting information in the mail). Quantitative data were collected at baseline, post-intervention (7-weeks post-baseline), and 3-months post-intervention. Qualitative data (semi-structured interviews) were collected from 11 intervention father completers following the second quantitative data collection timepoint. Multi-level modeling results indicated no statistically significant time-by-treatment findings for father involvement (b=0.03, 95% confidence interval [CI]: -0.03, 0.08, p=0.38), total corporal punishment (b=-0.03, 95% CI: -0.47, 0.41, p=0.89), or neglect (b=-0.13, 95% CI: -1.93, 1.68, p=0.89). Qualitative findings indicated that Dad2K completers exhibited positive knowledge and behavioral change related to parenting. Study limitations, lessons learned from this formative work, and recommendations for future research are discussed.

Trauma-informed schools: Child disaster exposure, community violence and somatic symptoms.

BACKGROUND: Given the increasing prevalence of natural disasters, trauma-informed school settings should include efficient methods for assessing child health and mental health in post-disaster environments. To develop such methods, factors that contribute to children's vulnerability and key signs of distress reactions after disasters need to be understood. To address these issues, we evaluated pre-disaster community violence exposure as a vulnerability factor for children's post-disaster reactions and somatic symptoms as a key post-disaster outcome. METHODS: We evaluated 426 children exposed to Hurricane Katrina at two timepoints (3-7 months and 13-17 months post-disaster). Structural equation models evaluated community violence exposure, hurricane exposure, and posttraumatic stress and somatic symptoms. RESULTS: Community violence exposure was associated with increased levels of posttraumatic stress symptoms among disaster-impacted youth, and did not moderate the relationship between disaster exposure and posttraumatic stress symptoms. Posttraumatic stress symptoms were associated with somatic symptoms in the short-term recovery period (3-7 months), but not associated with somatic symptoms during the longer-term recovery period (13-17 months). LIMITATIONS: This study did not include school-level factors, and somatic symptoms were based on parent reports. The study did not include parent functioning information or distinguish between whether somatic symptoms were medical or functional in nature. CONCLUSIONS: Post-disaster school-based screeners may need to incorporate questions related to children's past exposure to community violence and their somatic symptoms to provide trauma-informed care for children.