Continuing education training focused on the development of behavioral telehealth competencies in behavioral healthcare providers.

INTRODUCTION: Telehealth allows behavioral health care and specialty services to be extended to rural residents. Telehealth is an important resource for the Alaskan healthcare system, which is tasked with providing services to culturally diverse populations living in remote areas. Training competent providers to deliver telehealth services is vital for the implementation of successful telehealth programs. Yet, the literature is lacking in the area of provider behavioral telehealth competency training. METHODS: This study assessed the impact of a Behavioral Telehealth Ethical Competencies Training program on 16 behavioral health providers' development of behavioral telehealth competency. A total of 14 competencies were developed, which required participants to understand the roles and responsibilities of a behavioral telehealth coordinator working at the distal site as well as the roles and responsibilities of the therapist. Video vignettes evaluating the 14 competencies, self-reported competence surveys and follow-up surveys of progress on telehealth goals were utilized to assess effects of the training. RESULTS: Results indicated participants' behavioral telehealth competencies increased following training. Participants reported positive perceptions regarding their competency, and achieved progress on the majority of behavioral telehealth goals set during the training. CONCLUSIONS: This study provides a baseline for developing a best practice model for behavioral telehealth service delivery by identifying specific provider competencies for administering effective behavioral telehealth services. A unique continuing education training model, led by content experts including university professors and Alaska Native Elders, incorporating behavioral telehealth, rural ethics, cultural competency and vicarious trauma training is described. Lastly, this study details the use of an innovative video vignette assessment instrument for evaluating the effectiveness of continuing education training.

Memory functioning in adult women traumatized by childhood sexual abuse.

Memory impairment has been reported in some studies of patients with combat-related posttraumatic stress disorder (PTSD) and in rape victims with PTSD. The authors tested whether explicit memory impairment was evident in adult women who were traumatized by severe sexual abuse in childhood. The California Verbal Learning Test (Delis, Kramer, Kaplan, & Ober, 1987) and the Benton Visual Retention Task (Benton, 1974), were administered to 22 female adult survivors of childhood sexual trauma and to 20 demographically and educationally similar nonvictimized women. No evidence was found of explicit memory impairment in the abuse survivors. Furthermore, neither PTSD severity, dissociative symptom severity, nor extent of preexisting amnesia for childhood trauma contributed to the variance in memory functioning. Additional studies are needed to determine the extent to which impaired explicit memory functioning is a common feature of posttraumatic stress syndromes.

Enhanced dexamethasone suppression of plasma cortisol in adult women traumatized by childhood sexual abuse.

A study was undertaken to determine if female survivors of childhood and/or adolescent sexual abuse (CSA) would exhibit hypothalamic-pituitary-adrenal (HPA) axis abnormalities characteristic of patients with combat-related posttraumatic stress disorder (PTSD)--i.e., enhanced cortisol suppression to low-dose dexamethasone and increased density of lymphocyte glucocorticoid receptors. Nineteen women who reported experiencing severe CSA and 21 nonvictimized women participated in a low-dose (0.5 mg) dexamethasone suppression test and donated blood for measurement of lymphocyte glucocorticoid receptor binding. Women with CSA had significantly enhanced suppression of plasma cortisol in response to 0.5 mg dexamethasone compared to the nonvictimized women. These observations are consistent with findings in male veterans with combat-related PTSD. They suggest that this pattern of HPA axis dysfunction may be a characteristic sequel of psychiatric disorders that occur following a range of traumatic experiences. This HPA axis profile is different than that associated with acute stress or with major depressive disorder.

Hippocampal volume in women victimized by childhood sexual abuse.

BACKGROUND: Several prior studies have found reduced hippocampal volume in victims of psychological trauma with post-traumatic stress disorder (PTSD). We were interested to determine if this finding was evident in women who were victimized by severe sexual abuse in childhood. METHODS: In this study, hippocampal volume was measured using quantitative magnetic resonance imaging (MRI) in 21 women who reported being severely sexually abused in childhood and 21 socio-demographically similar women without abuse histories. RESULTS: Women who reported sexual victimization in childhood had significantly reduced (5% smaller) left-sided hippocampal volume compared to the non-victimized women. Hippocampal volume was also smaller on the right side, but this failed to reach statistical significance. Left-sided hippocampal volume correlated highly (rs = -0.73) with dissociative symptom severity, but not with indices of explicit memory functioning. CONCLUSIONS: These findings, which are generally consistent with prior reports of reduced hippocampal volume in combat veterans with PTSD, suggest that diminished hippocampal size may be either a consequence of trauma exposure or a risk factor for the development of psychiatric complications following trauma exposure. The observed relationship between symptom severity and hippocampal volume suggests that mesial temporal lobe dysfunction may directly mediate certain aspects of PTSD and dissociative disorder symptomatology.

Structural brain changes in PTSD. Does trauma alter neuroanatomy?

Although the impetus for studying hippocampal morphology and functioning in PTSD was the finding that stress could result in hippocampal damage in rodent and primate models, it is far from proven that the findings to date in PTSD represent defects that have been caused by trauma. It is equally possible that the findings represent a preexisting anomaly which might serve as a risk factor for the development of PTSD following trauma exposure. To resolve this dilemma, it is necessary to study persons at high risk for trauma (e.g., soldiers) prior to trauma exposure and ag in after exposure. Such methods will permit the determination not only of whether trauma alters hippocampal morphology, but also, if so, of whether this effect is limited to persons with PTSD. At the present time, the field would be well advised to proceed vigorously but with appropriate caution along these lines of research. As just outlined, sample sizes have been small, and potentially confounding variables have abounded in most studies. The next few years of research may well continue to replicate the finding of abnormal hippocampal morphology in PTSD. However, it would not be surprising to find that other brain regions are also involved and that these represent part of a broader risk spectrum for the development of psychopathology under stress. Until these issues are clarified, the neuroanatomical findings to date in PTSD should be viewed as tentative, tantalizing, and in need of additional study.

Relationship of child sexual abuse to depression.

Thirty-nine girls aged 6 to 12 participated in this study, each having been referred for evaluation of suspected child sexual abuse. The study investigated the prevalence of depression in the sample as well as the relationship of depressive symptoms to severity of abuse and potential mediator variables. The Child Behaviour Checklist and Child Depression Inventory were used to asses the severity of depression. A composite score for severity of abuse was derived from child disclosure and medical findings. Results indicated that 67% of the children could be classified as experiencing symptoms consistent with a diagnosis of depression. Severity of abuse was not significantly correlated with depression intensity scores. Stepwise regression analyses revealed that a high number of stressful life events and low IQ were significant predictors of depression scores. The clinical implications of these findings are discussed.