Communities Healing And Transforming Trauma (CHATT): A Trauma-Informed Speakers' Bureau for Survivors of Violence.

There is increasing recognition of the value of consumer participation in advocacy and community activism. Among trauma survivors, finding a sense of purpose and a way to make meaning from the trauma experience has been termed "survivor mission," and may include a call to social action, involvement in social justice activities, or public speaking. The current study describes the development of a trauma-informed trauma-survivor speakers' bureau (CHATT) and presents quantitative and qualitative outcome findings. The CHATT program encompasses (1) a speaker training component, (2) public speaking activities, and (3) speaking support groups. Trauma survivors (N = 27) who received trauma mental health (MH) services and were in the later stages of recovery completed the two-part seven-hour speaker training and subsequently presented talks at 13 venues to 192 audience members during a three-year study period. Speakers completed baseline measures prior to the training, and follow-up measures at six months and one year to assess posttraumatic growth (PTG) and self-efficacy. Audience members completed an assessment of change in beliefs about key speaker advocacy goals, as well as emotional reactions and satisfaction with talks. Results revealed PTG and speaking self-efficacy increased for speakers after one-year post-training. Audience ratings of talks averaged in the high range except for one domain. Ratings differed by audience type and number of speakers, and increased as the program matured. Key speaker advocacy successes including state policy changes, limitations, and implications for future research and development are discussed.

ANOTHER "LETHAL TRIAD"-RISK FACTORS FOR VIOLENT INJURY AND LONG-TERM MORTALITY AMONG ADULT VICTIMS OF VIOLENT INJURY.

BACKGROUND: Mental illness, substance abuse, and poverty are risk factors for violent injury, and violent injury is a risk factor for early mortality that can be attenuated through hospital-based violence intervention programs. Most of these programs focus on victims under the age of 30 years. Little is known about risk factors or long-term mortality among older victims of violent injury. OBJECTIVES: To explore the prevalence of risk factors for violent injury among younger (age < 30 years) and older (age 30 ≥ years) victims of violent injury, to determine the long-term mortality rates in these age groups, and to explore the association between risk factors for violent injury and long-term mortality. METHODS: Adults with violent injuries were enrolled between 2001 and 2004. Demographic and injury data were recorded on enrollment. Ten-year mortality rates were measured. Descriptive analysis and logistic regression were used to compare older and younger subjects. RESULTS: Among 541 subjects, 70% were over age 30. The overall 10-year mortality rate was 15%, and was much higher than in the age-matched general population in both age groups. Risk factors for violent injury including mental illness, substance abuse, and poverty were prevalent, especially among older subjects, and were each independently associated with increased risk of long-term mortality. CONCLUSION: Mental illness, substance abuse, and poverty constitute a "lethal triad" that is associated with an increased risk of long-term mortality among victims of violent injury, including both younger adults and those over age 30 years. Both groups may benefit from targeted risk-reduction efforts. Emergency department visits offer an invaluable opportunity to engage these vulnerable patients.

Characterizing Drug-Facilitated Sexual Assault Subtypes and Treatment Engagement of Victims at a Hospital-Based Rape Treatment Center.

Variation among existing studies in labeling, defining, identifying, and subtyping cases of suspected drug-facilitated sexual assault (DFSA) poses challenges to integrating research findings for public health purposes. This descriptive study addressed methodological issues of nomenclature and DFSA operational definitions to improve case identification and was designed to distinguish assault subtypes. We studied a 2-year ethnically diverse cohort of 390 patients who presented acutely to an urban rape treatment center (RTC). We abstracted data from RTC medical and mental health records via chart review. Assault incidence rates; engagement into medical, forensic, and mental health services; injury sustained; and weapon use were calculated separately for assault subtypes and compared. DFSA accounted for over half of the total sexual assault (SA) cases. Involuntary DFSA (in which an incapacitating substance was administered to victims without their knowledge or against their will) increased from 25% to 33% of cases over the 2-year period. DFSA victims presented sooner, and more often attended medical follow-up and psychotherapy than non-DFSA victims. Incidence rates indicated increasing risk for young males. These findings indicate that DFSA continues to be a growing and complex phenomenon and suggest that DFSA victims have greater service needs. The field would benefit from innovations to address symptomatology arising from this novel type of trauma and the unique risks and needs of male victims, as well as underscoring the ongoing need for DFSA-specific prevention efforts for both victims and perpetrators.

Mental health in violent crime victims: Does sexual orientation matter?

The present study investigates victim sexual orientation in a sample of 641 violent crime victims seeking emergency medical treatment at a public-sector hospital. Victim sexual orientation was examined as it: (a) varies by type of violent crime and demographic characteristics, (b) directly relates to psychological symptoms, and (c) moderates the relationship between victim and crime characteristics (i.e., victim gender, victim trauma history, and type of crime) and psychological symptoms (i.e., symptoms of acute stress, depression, panic, and general anxiety). Results showed that lesbian, gay, bisexual, and transgender (LGBT) victims were more likely to be victims of sexual assault. Heterosexual victims were more likely to be victims of general assault and shootings. LGBT victims demonstrated significantly higher levels of acute stress and general anxiety. Moreover, victim sexual orientation moderated the association of type of crime with experience of panic symptoms. Also, victim sexual orientation moderated the relation of victim trauma history and general anxiety symptoms. Results are discussed in relation to victimization prevalence rates, sexual prejudice theory, and assessment and treatment of violent crime victims.

Outreach, engagement, and practical assistance: essential aspects of PTSD care for urban victims of violent crime.

The purpose of this article is to examine the literature on the increased risk factors of disadvantaged inner-city residents for becoming victims of violence and for developing posttraumatic stress disorder (PTSD) and barriers to accessing comprehensive mental health services. Second, the article discusses the limitations of evidence-based treatments for early intervention with urban victims of violence and provides a new model of care emphasizing outreach, engagement, and practical assistance. Finally, the article concludes with recommendations for comprehensive hospital-based urban programs in terms of practice, policy, and research.

Psychoeducation to address stigma in black adults referred for mental health treatment: a randomized pilot study.

Forty-two Black clients referred for outpatient treatment were randomly assigned to receive existing brochures about services or a psychoeducational booklet about stigma based on experiences of Black mental health consumers. At 3-month follow-up, clients reported that both types of information were helpful; there were no significant differences between the types of information on treatment attendance. However, individuals who reported higher perceived treatment need or greater uncertainty about treatment showed greater stigma reduction from the psychoeducation. Findings indicate the need to move beyond "customer satisfaction" to evaluate educational interventions, as well as for greater understanding of differential impact of stigma reduction interventions.

Reduction of state victim compensation disparities in disadvantaged crime victims through active outreach and assistance: a randomized trial.

OBJECTIVES: We examined whether providing active outreach and assistance to crime victims as part of comprehensive psychosocial services reduced disparities in access to state compensation funds. METHODS: We analyzed data from a randomized trial of injured crime victims (N = 541) and compared outcomes from comprehensive psychosocial services with usual community care. We examined the impact of outreach and assistance on disparities in applying for victim compensation by testing for interactions between victim characteristics and treatment condition in logistic regression analyses. RESULTS: Victims receiving comprehensive services were much more likely to apply for victim compensation than were victims receiving usual care. Comprehensive services decreased disparities associated with younger age, lower levels of education, and homelessness. CONCLUSIONS: State-level victim compensation funds are available to help individuals recover physically, psychologically, and financially from crime victimization. However, few crime victims apply for victim compensation, and there are particularly low application rates among young, male, ethnic minority, and physical assault victims. Active outreach and assistance can address disparities in access to victim compensation funds for disadvantaged populations and should be offered more widely to victims of violent crime.

Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial.

OBJECTIVE: The objective of the study was to test the hypothesis that clinical case management is more cost-effective than usual care for frequent users of the emergency department (ED). METHODS: The study is a 24-month randomized trial obtaining data on psychosocial problems through interviews and service usage and cost data from administrative records. RESULTS: Two-hundred fifty-two frequent users were randomized (167 to case management, 85 to usual care). Case management was associated with statistically significant reductions in psychosocial problems common among ED frequent users, including homelessness, alcohol use, lack of health insurance and social security income, and financial need. Case management was associated with statistically significant reductions in ED use and cost. Case management and usual care patients did not differ in use or cost of other hospital services. CONCLUSIONS: Case management appears cost-effective for ED frequent users because it yields statistically and clinically significant reductions in psychosocial problems at a cost similar to that of usual care.

Characteristics and psychosocial needs of victims of violent crime identified at a public-sector hospital: data from a large clinical trial.

OBJECTIVE: This study explores the feasibility of recruiting acutely injured public-sector crime victims into a research protocol and identifies baseline characteristics associated with posttraumatic distress in the enrolled sample (N=541). METHOD: Assertive research tracking methods were used to enroll participants, who completed baseline interviews. Descriptive statistics were used to define characteristics of the sample and prevalence of psychosocial problems and posttraumatic distress. Multiple regression analysis was performed to identify predictors of posttraumatic distress. RESULTS: A high percentage (78%) of eligible victims completed baseline interviews within 1 month of victimization. The sample was largely male, ethnic minority, unemployed and living below the poverty level. Trauma symptoms were highly prevalent, with three quarters having significant posttraumatic distress. Female gender, preexisting psychiatric disorder, trauma history, case management needs and employment status were predictive of greater symptomatology. Stabbing victims had lower distress. CONCLUSIONS: Comprehensive mental health and case management services that proactively engage disadvantaged victims are needed to meet the complex problems of this population.