Peer-led seeking safety: results of a pilot outcome study with relevance to public health.

Abstract There is a rich history of peer-led recovery efforts related to substance use disorder (SUD). Yet we know of no peer-led approaches for co-occurring SUD and trauma-related problems. This combination is widespread, has impact on multiple life domains, and presents major recovery challenges. In this pilot, we evaluated peer-led Seeking Safety (SS). SS is the most evidence-based and widely implemented therapy for SUD with co-occurring PTSD or other trauma-related problems. Eighteen women in residential substance-abuse treatment participated. All met SUD criteria (primarily opiate and cocaine dependence); most had a comorbid mental health disorder; and they had elevated trauma-related symptoms. The 25 SS topics were conducted twice-weekly. Participants were assessed at baseline and end-of-treatment, with some measures also collected monthly. Results showed significant positive outcomes in trauma-related problems (the Trauma Symptom Checklist-40); psychopathology (the Brief Symptom Inventory); functioning (the BASIS-32, including impulsive-addictive behavior); self-compassion (the Self-Compassion Scale); and SS coping skills. Effect sizes were consistently large. SS satisfaction and fidelity ratings were high. Substance use levels could not be assessed due to the residential setting. Qualitative data indicated enthusiasm for peer-SS by both peers and staff. Study limitations, future research, and public health relevance are discussed.

Assessment of the needs of vulnerable youth populations in post-conflict Liberia.

OBJECTIVE: The study examined key informants' perceptions of the emotional impact of traumatic events, major problems, functional limitations and appropriate treatment settings for children, adolescents, and young adults in post-conflict Liberia. METHOD: This research is a based on cross-sectional survey conducted between March 30, 2009 and April 30, 2009 in Liberia with 171 local key Liberian informants. Analysis was conducted using mixed methods. The findings we will report were collected in the qualitative portion of the survey. RESULTS: We found that while different interventions were preferred for different types of young people, some interventions were mentioned for all youth and by all age and gender groups of key informants. These included counseling, education, and skills training. Also frequently chosen were housing, community reintegration, recreation, and medical care. In general, key informants reported similar concerns regardless of their ages or genders. Notable exceptions to this were in interventions for youth who joined fighting forces. Men over 50 were the only ones to recommend apology and reparations. Similarly, in recommendations for criminals and violent youth, a number of men mentioned prison, whereas the women did not. CONCLUSION: Our findings suggest that the needs of post-conflict Liberian youth span a variety of domains, including physical, emotional, medical, psychological, and educational. These findings can be used to guide the development of treatment programs for these young people.

Reductions in traumatic stress following a coping intervention were mediated by decreases in avoidant coping for people living with HIV/AIDS and childhood sexual abuse.

OBJECTIVE: To examine whether (a) Living in the Face of Trauma (LIFT), a group intervention to address coping with HIV and childhood sexual abuse (CSA), significantly reduced traumatic stress over a 1-year follow-up period more than an attention-matched support group comparison intervention; and (b) reductions in avoidant coping over time mediated reductions in traumatic stress. METHOD: In a randomized controlled trial, 247 participants completed measures of traumatic stress and avoidant coping at pre- and post intervention, and at 4-, 8-, and 12-month follow-ups. Latent growth curve modeling examined changes over the 5 time points; standardized path coefficients provide estimates of effects. RESULTS: As compared with the support intervention, the coping intervention led to a reduction in traumatic stress over time (b = -.20, p < .02). Participants in the coping intervention also reduced their use of avoidant coping strategies more than did participants in the support intervention (b = -.22, p < .05). Mediation analyses showed reductions in avoidant coping related to reductions in traumatic stress (b = 1.45, p < .001), and the direct effect of the intervention on traumatic stress was no longer significant (b = .04, ns), suggesting that changes in avoidant coping completely mediated intervention effects on traumatic stress. CONCLUSIONS: The LIFT intervention significantly reduced traumatic stress over time, and changes in avoidant coping strategies mediated this effect, suggesting a focus on current stressors and coping skills improvement are important components in addressing traumatic stress for adults living with HIV and CSA.

Prevalencia de lesiones en triatletas de una liga francesa / Prevalence of injuries in triathletes from a French league

Objetivo: Evaluar la prevalencia de traumatismos en triatletas y buscar los factores contribuyentes implicados. Método: Se envió por correo un cuestionario anónimo sobre los casos de traumatismos durante la temporada pasada a 788 triatletas de una liga francesa. Resultados: El 52,4% de los triatletas que respondieron notificaron que habían sufrido como mínimo una lesión durante la temporada pasada y el 17% varias lesiones. El 83,5% de las lesiones se produjeron durante el entrenamiento, sobre todo corriendo (72,5%). Los casos notificados con más frecuencia fueron tendinopatías (44,5%) y lesiones musculares (35%). Las zonas anatómicas notificadas con más frecuencia fueron el tobillo (20,6%), la rodilla (18,3%), el muslo (15%), la región lumbar (12,6%) y el hombro (8,3%). El 77% de los triatletas lesionados pudieron seguir entrenando, sobre todo haciendo natación (71%) y ciclismo (61,5%), mientras que en el 85,5% de los casos tuvieron que dejar de correr. Los triatletas que habían sufrido lesiones notificaron que dedican un tiempo significativamente menor al calentamiento que los triatletas ilesos (respectivamente, 13,7min frente a 18min) (p<0,01). El tiempo dedicado a los estiramientos también era inferior en los lesionados en comparación con los ilesos (respectivamente, 8,3min frente a 10,6min) (p<0,01). Se observó la misma asociación entre el tiempo empleado en el calentamiento y el estiramiento y la prevalencia de tendinopatías. La prevalencia de lesiones musculares se asoció de manera significativa con el número de horas de entrenamiento semanales (p<0,05) y con la distancia de entrenamiento semanal nadando, haciendo ciclismo y corriendo (p<0,05). Conclusión: Las lesiones observadas en triatletas amateurs son lesiones musculoesqueléticas por «abuso», producidas sobre todo durante el entrenamiento, principalmente al correr(AU)

Objective: To assess the prevalence of trauma injuries in triathletes and look for contributing factors involved. Method: An anonymous questionnaire about trauma history during the past season was sent by post to 788 triathletes from a French league. Results: 52.4% of triathletes responding reported having been injured at least once during the past season, for 17% of them several times. 83.5% of injuries occurred during training, mostly in running (72.5%). The tendinopathies (44.5%), and muscle injuries (35%), were the most frequently reported. The anatomical sites most frequently reported were the ankle (20.6%), knee (18.3%), thigh (15%), lumbar region (12.6%) and shoulder (8,3%). 77% of injured triathletes were able to keep training, mainly in swimming (71%) and cycling (61.5%), while running was stopped in 85.5% of cases. Injured triathletes reported devote significantly less time to warm-up than uninjured triathletes (respectively 13.7min vs. 18min) (p<0.01). Time devoted to stretching was also lower for injured vs. uninjured (respectively 8.3min vs. 10.6min) (p<0.01). The same association was also found between time spent warming up and stretching and the prevalence of tendinopathies. The prevalence of muscle injuries was significantly associated with number of training hours per week (p<0.05) and weekly training distance swimming, cycling and running (p<0.05). Conclusion: Injuries encountered in amateur triathletes are musculoskeletal injuries of «overuse», occurring mainly in training, especially running(AU)

Trauma rehabilitation for war-affected persons in northern Uganda: a pilot evaluation of the EMPOWER programme.

OBJECTIVES. This study evaluated the impact of a culturally sensitive cognitive behaviour therapy (CBT)-based intervention (the EMPOWER programme) for war-affected persons in northern Uganda. DESIGN. The study conducted a pilot evaluation with a convenience sample of participants from internally displaced persons (IDPs) camps (i.e., a treatment camp and waitlist control camp). This was done to avoid treatment effects spreading from the intervention to control conditions. METHODS. A total of 202 participants (N= 90 treatment participants and N= 112 control participants) were included as a convenience sample. The Acholi Psychosocial Assessment Instrument (APAI), a culturally appropriate measure of psychosocial functioning, was administered to participants residing in two IDP camps at pre-treatment, post-treatment, and at 3-month follow-up. Participants in the treatment camp received the EMPOWER programme--a culturally sensitive CBT-based intervention teaching emotional resiliency and promoting forgiveness. RESULTS. Participants in the treatment condition reported (a) significantly lower scores on the depression-like syndromes and the anxiety-like syndrome and (b) significantly more prosocial behaviours, than participants in the control condition. CONCLUSIONS. The results of this study provide initial support for the application of structured CBT interventions in war-affected areas, illustrating that the EMPOWER programme could be utilized by humanitarian agencies to address the psychosocial needs of war-affected displaced persons.

Trauma adapted family connections: reducing developmental and complex trauma symptomatology to prevent child abuse and neglect.

Families living in urban poverty, enduring chronic and complex traumatic stress, and having difficulty meeting their children's basic needs have significant child maltreatment risk factors. There is a paucity of family focused, trauma-informed evidence-based interventions aimed to alleviate trauma symptomatology, strengthen family functioning, and prevent child abuse and neglect. Trauma Adapted Family Connections (TA-FC) is a manualized trauma-focused practice rooted in the principles of Family Connections (FC), an evidence supported preventive intervention developed to address the glaring gap in services for this specific, growing, and underserved population. This paper describes the science based development of TA-FC, its phases and essential components, which are based on theories of attachment, neglect, trauma, and family interaction within a comprehensive community-based family focused intervention framework.

Psychometric properties of the Worker Role Self-assessment instrument used to evaluate unemployed people in Sweden.

The aim was to determine the psychometric properties of the new Worker Role Self-assessment (WRS) instrument. The content validity, utility, test-retest reliability, sensitivity to change, and predictive validity of the WRS were investigated in two subject samples, which were selected at work and pain rehabilitation clinics, respectively. One of these groups consisted of 23 clients and four occupational therapists, and the other comprised 83 clients. All clients in both samples were unemployed. The results showed that both the clients and the occupational therapists perceived the content validity and the utility of the WRS as good. The test-retest reliability showed mostly good to moderate agreement, and the internal consistency was satisfactory. One of the items showed predictive validity for work capacity, and the same item was sensitive to change. However, a ceiling effect reduced the utility and the sensitivity to change. Our findings indicate that the WRS is promising as a tool that clinicians can use to evaluate the capacity for return to work and for planning interventions, although some revisions are needed to counteract the ceiling effect.

Clinical outcomes of traumatized youth in adolescent substance abuse treatment: a longitudinal multisite study.

The purpose of this study was to evaluate the effectiveness of outpatient substance abuse treatment for youth with high traumatic stress compared to youth without high traumatic stress in substance abuse treatment centers across the United States. The data for this study were gathered using a longitudinal survey design with purposive sampling from nine drug treatment delivery systems across the United States participating in the cooperative grant Strengthening Communities for Youth (SCY) awarded by SAMHSA's Center for Substance Abuse Treatment (CSAT) between September 2002 and June 2006. Follow-up assessments were conducted with the youth at three,six, and 12 months following intake. Traumatized youth responded to outpatient treatment in a similar pattern when compared to nontraumatized youth, although the traumatized youth had consistently higher scores on substance use frequency and substance problems scales than nontraumatized youth throughout the study. Current empirically validated treatments for adolescent substance abuse do not prepare the practitioner for trauma-informed practice or specifically address trauma-informed recovery. Based on our results, we advocate for the development and integration of trauma-informed practice within substance abuse treatment for adolescents to help them recover from trauma and substance abuse issues.

Psychosocial care for adult and child survivors of the 2004 tsunami disaster in India.

The tsunami disaster in South Asia affected the mental health of thousands of survivors, but psychological aspects of rehabilitation are frequently overlooked in public health initiatives. From January to March 2005, teams from the National Institute of Mental Health and Neurosciences in Bangalore, India, traveled to south India and implemented a "train the trainer" community-based mental health program of psychosocial care to facilitate the recovery of child and adult survivors. Psychosocial care has applications to natural and man-made disasters in developing countries.

A model of care for managing traumatic psychological injury in a workers' compensation context.

Work-related traumatic psychological injuries are a significant health problem that can result in distress and disability. To improve outcomes following a workplace trauma, the Workers' Compensation Board of Alberta (WCB-AB) has developed and implemented an evidence-based care model (CM) to assist its staff to manage these claims. A CM acts as a disability management "road map" that illustrates typical recovery patterns, treatment best practices, and checkpoints where decisions for further service provision can be made. The model was developed from a recent literature review, and the opinions of local and international experts in the field of traumatic psychological injury. A formal evaluation of the effectiveness of this model is being planned.

A developmental approach to understanding drawings and narratives from children displaced by Hurricane Katrina.

Using art as a process to help children externalize complex feelings can add another layer of assessment in the primary care setting. In the face of trauma, drawing may help children gain symbolic control over events that are confusing and frightening. Through examples of children who were affected by Hurricane Katrina, this article describes the use of drawings and narratives to understand children's experiences related to traumatic displacement. Recommendations include using a developmental lens to understanding children's art, asking children to talk about their drawings, and considering the significance of place for children who have been traumatically displaced.

Management of trauma in special populations after a disaster.

Special populations are particularly vulnerable to mental health problems in the aftermath of a disaster. Efficient delivery of mental health services, the integrated use of psychosocial services and mental health facilities, and the active intervention of trained community health care workers can offer effective management of the psychosocial problems of special populations. Women, children, adolescents, the poor, the elderly, and individuals with preexisting health problems have been identified as special populations who often suffer psychological morbidity as a result of a catastrophic disaster. Understanding the cultural, ethnic, and socioeconomic factors in a postdisaster situation is crucial to helping special populations overcome debilitating mental illness and declining quality of life. Planning the delivery of mental health services is critical and includes hazard mapping to identify vulnerable geographic and social areas, screening instruments to identify at-risk populations, and education of community leaders and health care workers. An integrated approach using psychosocial and institutionalized interventions can provide better outcomes than either approach alone. A community-based approach with trained grassroots health care workers can provide effective psychosocial support and rehabilitation services.

An Internet-based self-change program for traumatic event related fear, distress, and maladaptive coping.

This study compared the efficacy of an Internet-based, 8-week self-help program for traumatic event-related consequences (SHTC) (n = 13) to a wait-list (WL) condition (n = 14). The SHTC consisted of cognitive-behavioral modules that progressed from the least anxiety-provoking component (i.e., information) to the most anxiety-provoking (i.e., exposure). Participants were those who had experienced a traumatic event and had been experiencing subclinical levels of symptoms associated with the event. Participants mastered the material in each module before proceeding to the next module. Pre- and post-treatment assessments revealed that SHTC participants decreased avoidance behavior, frequency of intrusive symptoms, state anxiety, and depressive symptoms, and increased coping skills and coping self-efficacy significantly more than WL participants. SHTC participants demonstrated more clinically significant improvement than WL individuals.

Psychological impact of disasters and terrorism on children and adolescents: experiences from Australia.

Recent acts of terrorism have emphasised the need for research to further establish not only the nature of the impact of disaster and terrorism on the population, but also further define methods of effective intervention. Those affected, and often overlooked, include children and adolescents, yet, our knowledge of the impact upon the younger members of our community is limited. The literature is evolving, and there are a small number of valuable studies that can inform a response to the mental health needs of this younger population. This article reviews some of the psychological impacts of disaster and terrorism upon children and adolescents, and considers both risk and protective factors. The importance of a developmental approach to children's understanding of disaster, particularly death and the nature of grief and loss are discussed as is the distinction between the phenomenology of bereavement and trauma. Family and community support are highlighted as protective factors, and a number of recent, valuable recommendations for intervention including psychological first aid and cognitive-behavioral therapy are described. Finally, the complex role of the media and the degree that children should be exposed to images of violence and disaster is considered. Disasters, whether they are natural or human-made always will be with us. It is necessary that a public-health approach that not only prepares for such scenarios, but responds by maximising the use of existing systems and agency linkages, is taken.

Burial at Srebrenica: linking place and trauma.

Five years after the massacre at Srebrenica in Bosnia-Herzegovina, survivors were faced with the decision: where did they want their loved ones buried? This report explores the reasons for their choice in qualitative interviews with 37 survivors of the massacre and 22 key informants performed over the summer 2000. Survivors wanted the loved ones buried at Potocari, a site just outside of Srebrenica, because it represented the site of ultimate horror, was connected to their sense of home, and underscored the various power relationships. The data points to the importance of place for health. Trauma, as it occurs in particular locations, breaks the sense of attachment to a particular place. Restoring the physical and social environment through burial and memorials mitigates the consequences of the trauma. The burial at Potocari provides a window into the mourning, politics, and recovery after mass violence.