Child-focused, school-based prevention is the most common type of universal prevention of child sexual abuse (CSA) utilized in the United States (U.S.). Implementation of school-wide CSA primary prevention programming in busy urban elementary schools in high-need communities can be complex, made even more so by the sensitive nature of the topic of CSA. The Healthy Relationships Project (HRP), created by Prevent Child Abuse Vermont, consists of manualized, developmentally-appropriate, CSA primary prevention curricula implemented since 1990 in 30 U.S. States. Informed by the Social Ecological Model by Bronfenbrenner, the HRP works across ecological levels with curricula that include training for school staff, six classroom lessons, and caregiver workshops. A rigorous stepped-wedge randomized trial to evaluate schoolwide implementation of the HRP in public and public-charter schools in high-need wards in Washington, DC, among Pre-K through 5th grade students is underway. Prior to the trial's start, the research team evaluated a pilot of the intervention in one public charter school. This pilot study involved mixed-methods research consisting of pre-intervention surveys with staff/faculty (n = 27) and caregivers (n = 27), pre- and post-intervention interviews with staff, faculty and caregivers (n = 4), and a post-intervention focus group with staff/faculty (n = 1 focus group with four participants). Strengths and challenges of implementation, the sensitivity associated with the topic of CSA, and the acceptability and feasibility of engagement of stakeholders were identified as themes. The complexities of implementation of this CSA prevention model in an urban public-charter school, in a high-need neighborhood, will be presented for others implementing similar preventive interventions.

While the COVID-19 pandemic’s impact on mortality and morbidity is becoming more understood, the severity of the long-term effects remains unknown: this includes medical sequelae of long COVID but also the impact of the social and economic upheaval on population health. Working parents faced many challenges during the pandemic, and the impact of these on the mental health and well-being of parents has been demonstrated. However, the extent of trauma-related symptoms among working parents who have faced unique challenges related to the virus itself and the social and structural consequences of containment efforts remains underexamined. Using data from a national panel survey of fworking parents (n = 1941), we explored the relationship between workplace policies and practices and COVID-19-related PTSD and psychological distress. Results demonstrate that nearly 50% of working parents experienced COVID-19-related PTSD as measured by the Impact of Events Scale-6, and over 60% had moderate to high levels of psychological distress. We examined mechanisms to understand the impact of job support on employees’ levels of PTSD and distress and found that both socio-demographic factors and workplace support related to levels of PTSD and distress among working parents. Our study highlights the distress and PTSD levels experienced by working parents in the early stages of the pandemic, underscoring the impact of workplace support on mental health outcomes.

Emergency medical services (EMS) professionals are exposed to the trauma experienced by their patients regularly. This exposure to others’ traumatic experiences is known as vicarious trauma or indirect trauma. When it becomes problematic for the worker’s well-being, the resulting symptoms are referred to as vicarious traumatization or secondary traumatic stress. Existing literature highlights the importance of recognizing vicarious trauma and subsequent symptoms experienced by these professionals, as well impacts this may have on their workplaces. However, comprehensive reviews of vicarious traumatization among those involved in responding to prehospital emergency medical situations are limited. A four-phase Preferred Reporting Items for Systematic Reviews and Meta-Analyses selection process was employed to identify publications from 1995 to 2022 that considered the epidemiology of vicarious traumatization among EMS professionals. Trained reviewers screened articles based on inclusion criteria: (a) EMS professionals; (b) vicarious traumatization/related terms; and (c) analysis of epidemiological data on prevalence, risk/protective factors, or manifestations. Initially, 4,147 unique manuscripts were identified. After removing duplicates, one reviewer screened titles, and additional articles were identified through bibliography searches. Two reviewers independently screened abstracts, resolving disagreements during full-text screening, where a third reviewer settled any conflicts. A total of 31 articles were included in this review. Findings regarding the epidemiology of vicarious traumatization are summarized. The occupational hazard of vicarious/indirect trauma is unavoidable, but vicarious traumatization/secondary traumatic stress can be mitigated with improved workplace measures.

Vicarious trauma (VT) is an occupational challenge incurred through hearing about traumatic experiences of others such as child maltreatment, mass casualties, and others while serving in helping professions. Without sufficient resources and support, long-term exposure can lead to symptoms such as intrusion, avoidance, arousal, emotional numbing, anxiety, and decline in one's ability to work. Organisations can mitigate VT's impact by addressing the needs of staff through 5 evidence-informed areas of occupational health. This project explored the impact of VT-informed practices on organisational responses to the COVID-19 pandemic. We compared responses from 50 organisations on strengths and weaknesses in core areas of being VT-informed to how those organisations responded to the COVID-19 pandemic. Subscales of the VT Organizational Readiness Guide (VT-ORG) were utilized as the exposure variables and 4 new COVID-19 questions served as the outcome. We ran a series of multilevel linear regression models with clustering controlled for at the organisational level. Staff ratings on 4 of the 5 pillars of the VT-ORG were positively associated with the organisation's responsiveness to the pandemic. Various demographic factors of the employees were negatively associated with organisations' responsiveness to the pandemic. While this study contributes to the growing research on VT, it also provides justification for helping organisations to become VT-informed; it provides evidence that being prepared for VT can also be useful to support workers and their communities during emergencies such as the COVID-19 pandemic.

Abstract Background Pregnancy presents a critical period for any maternal and child health intervention that may impact the health of the newborn. With low antenatal care attendance by pregnant women in health facilities in Nigeria, community-based programs could enable increased reach for health education about sickle cell disease (SCD) and newborn screening (NBS) among pregnant women. This pilot study aimed to assess the effect of education on the knowledge about SCD and NBS among pregnant women using the Healthy Beginning Initiative, a community-based framework. Methods A pre-post study design was used to evaluate knowledge of SCD and NBS in a convenience sample of 89 consenting pregnant women from three communities. Participants were given surveys prior to and following completion of a health education session. McNemar’s test was used to compare the proportion of participants with correct responses. The level of significance was taken as p < 0.05. Results Compared to pre-test values, post-test values showed that participants understood that SCD is hereditary (93.3% vs. 69.7%), both parents must have at least one gene for someone to have SCD (98.9% vs. 77.5) and blood test is the right way to know if one has SCD (98.8% vs. 78.7%). Also, a large proportion of participants (post-test ~ 89.9%; compared to pre-test ~ 23.6%) understood that the chance of conceiving a child with SCD was 25% for a couple with the sickle cell trait (SCT). Knowledge of the possibility of diagnosing SCD shortly after birth was highly increased in the post test phase of the study when compared to the pre-test phase (93.3% vs. 43.9%, respectively). Concerning the overall knowledge scores, those with high level of knowledge significantly increase from 12.6% pretest to 87.4% posttest (p = 0.015). Conclusion The health education intervention was associated with significant improvement on almost all measures of SCD knowledge. Focused health education for pregnant women using community structures can improve knowledge of SCD and NBS.

Immigrants in the United States suffer high rates of domestic violence (DV). Using data from six focus groups with 38 DV service providers, we examined how immigrant survivors navigate an often-hostile political climate and identified structural barriers to healing and help-seeking. Findings indicated that structural discrimination, social exclusion, and dehumanization compound existing trauma and negatively impact survivors’ well-being. Results underscore the need to restructure pathways of immigration relief such as the U Visa and the Violence Against Women Act (VAWA) Self-Petition. Structural interventions targeting the immigration system and enhancing access to more secure legal status could serve to augment population health.

Emerging research indicates an immense burden on children and families related to the COVID-19 pandemic. This study uses data from semi-structured interviews and focus groups with early childhood service providers (n=19) to demonstrate the pandemic's impact on families with very young children and early childhood services in two high-need communities in Massachusetts, USA. We found that although the pandemic has worsened existing inequities and severely limited resources for young children and families, community mobilization in response to the crisis and innovative strategies stemming from resilience were developed quickly. Findings highlight the usefulness of early childhood systems of care in crisis responses and leveraging public-private cooperation to serve the needs of diverse families with young children. Lessons learned are applicable to global settings with high pre-pandemic inequities and can be used to develop stronger models of crisis response within the early childhood sector in preparation for future crises.

Social support is closely linked to health, but little is known about United States (U.S.) veterans' social support over time and factors that may influence their support trajectories. This study investigates social support over time for U.S. men and women Post-9/11 veterans in relation to trauma history and gender. A secondary analysis of longitudinal cohort data from the Survey of Experiences of Returning Veterans (SERV), which employed a repeated-measures longitudinal design using five waves of data (baseline, 3, 6, 9, 12 months) with 672 combat veterans. Results from random intercept multilevel models found no significant gender differences in social support over time. Veterans with complex trauma histories were at risk for lower social support across waves. A stability trend was also observed; specifically, at baseline, veterans who started with high support maintained their level over time whereas veterans who started with deficits in social support remained low over time. Veterans identifying as African American or Latinx, and those with lower annual incomes, reported lower support compared to White and higher-income veterans. Furthermore, low social support was significantly associated with severe posttraumatic stress symptoms and active suicidal ideation across 12 months. SERV utilized a nonrandom sampling method that may reduce generalizability of findings. There is also potential for residual confounding by factors related to both social support levels and time since discharge that were not available in this data set. Findings have implications for developing clinical and community interventions intended to support veterans as they transition back to the community. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Massachusetts Multi-City Young Children's System of Care Project was a federally funded program to provide integrated early childhood mental health (ECMH) services in primary care for families of very young children (birth-six years old) with Serious Emotional Disturbances across three cities in Massachusetts, U.S.A. This study describes lessons learned from the implementation of this program and makes recommendations for best practices to improve the delivery and efficacy of ECMH services in primary care settings. Staff and leadership (n = 35) from 11 agencies (primary care practices, community service agencies, and local health departments) that co-implemented this program participated in focus groups and semi-structured key informant interviews. Thematic analysis was used to characterize specific facilitators and barriers to successfully implementing system-wide programming for ECMH. Four main themes were identified: (1) Strong multilevel working relationships are critical for integration, (2) Capacity-building activities can be leveraged to improve implementation, (3) Financial challenges are a primary barrier to building efficacious systems of care, and (4) Flexibility and resourcefulness can help overcome logistical challenges in integration. Implementation lessons learned may serve as guidance for other states and institutions in the U.S. seeking to improve the integration of ECMH services into primary care. They may also provide strategies to adapt and scale these interventions to improve the mental health and well-being of young children and their families.

INTRODUCTION:Sexually assaulted patients who seek care in emergency departments are often recommended for nonoccupational HIV postexposure prophylaxis treatment. HIV postexposure prophylaxis is an effective method in preventing HIV transmission if the treatment is administered promptly and if a full 28-day course is completed. However, research has shown that only a fraction of patients who start the treatment will complete a 28-day course. Research is needed to explore factors that may be associated with compliance to postexposure prophylaxis so that interventions can be designed to address the factors that put patients at risk for noncompletion. METHODS:A retrospective chart review was conducted examining 246 medical records of sexually assaulted female patients who presented to one of two urban hospitals. A number of patient and event-related factors were examined to determine whether they were associated with HIV postexposure prophylaxis adherence among patients presenting at an emergency room after a sexual assault. RESULTS:Results revealed that five factors showed significant associations with sexually assaulted female patients completing HIV postexposure prophylaxis treatment. These factors include educational level, employment, health insurance, vaginal injuries, and tongue-mouth assaults. IMPLICATIONS FOR PRACTICE:The results of this study represent a starting point from which to inform the development of targeted interventions such that those most at risk for nonadherence can receive additional support or services to improve HIV postexposure prophylaxis adherence.

Understanding early childhood mental health service utilization in community-based clinical settings is important. Project Linking Actions for Unmet Needs in Children's Health (Project LAUNCH) provided mental health-related services for young children and families within pediatric medical homes. Using data from the Project LAUNCH evaluation (n = 106), we implemented negative binomial regression models to determine if baseline variables were associated with service utilization, defined as the number of encounters between the family and the team. Past-year homelessness emerged as a significant predictor of service utilization. Encounters for families with children who experienced homelessness within the last 12 months occurred at a rate 34.5% lower than those who had not experienced homelessness. Results highlight the importance of addressing homelessness as a barrier to mental health service utilization for families. Screening for recent housing insecurity and developing interventions that integrate housing support services into mental health programs may inform strategies to increase attendance for families with young children.

Background Despite the large body of research on the adverse effects of income inequality, to date, few studies have examined its impact on sleep. The objective of this investigation is to examine the association between US state income inequality and the odds for regularly obtaining inadequate (< 7 h) and very inadequate (< 5 h) of sleep in the last 24 h. Methods We analysed data from 350,929 adults participating in the US 2018 Behavioral Risk Factor Surveillance System (BRFSS). Multilevel modeling was used to determine the association between state-level income inequality, as measured by the Gini coefficient, and the odds for obtaining inadequate and very inadequate sleep. We also determined if associations were heterogeneous across gender. Results A standard deviation increase in the Gini coefficient was associated with increased odds for inadequate (OR = 1.06, 95% CI: 1.00, 1.13) and very inadequate sleep (OR = 1.11, 95% CI: 1.03,1.20). Also, a cross-level Gini Coefficient X Gender interaction term was significant (OR = 1.07, 95% CI:1.01,1.13), indicating that increasing income inequality was more detrimental to women’s sleep behavior. Conclusion Future work should be conducted to determine whether decreasing the wide gap between incomes can alleviate the burden of income inequality on inadequate sleep in the United States.

The present study examined revictimization, defined as sexual or physical assault in adulthood that followed a history of childhood maltreatment. We aimed to identify factors associated with revictimization over time in a group of U.S. military veterans deployed following the September 11, 2001, terrorist attacks (9/11). As revictimization is associated with multiple negative mental health outcomes in the literature, identifying risk and protective factors can aid in the prevention of revictimization and associated poor health outcomes among veterans. In this sample, the proportion of adult revictimization was 2.7% for men, 95% CI [2.0, 3.6] and 22.9% for women, 95% CI [20.5, 25.8]. Using multilevel logistic models, we found that women, β = 2.2, p < .001; Navy veterans, β = 1.5, p < .001; and participants who reported posttraumatic stress symptoms, β = 0.2, p = .028, were at significantly higher risk of revictimization across time compared to nonrevictimized counterparts. Social support while in the military was protective, β = -0.1, p < .001, against revictimization. In addition, childhood abuse experiences combined with characteristics such as female gender were related to an increased risk of revictimization during and following military service. The findings highlight opportunities for intervention and areas of strength within this population; social connection garnered during military service may serve as a protective factor against revictimization. Future research is needed to examine the role of social support in possibly lowering veterans' risk of revictimization over time, particularly for post-9/11 veterans struggling with transitioning from military to civilian life.

Sexual violence is a prevalent crime but vastly underreported and with serious long-term health consequences for survivors. Disclosure of sexual violence represents a social experience that may offer support towards healing or further traumatization depending on the response received. Although current research suggests that process of disclosure itself is important, as are social responses, there is a dearth of research examining the perceived impact of initial responses to disclosure on healing and relationships, particularly over time. The current study used data from nine focus groups with 45 survivors to explore the impact of initial disclosure reactions on recovery, from the survivors' perspectives. Constant comparative analysis identified several themes, including subtypes of positive and negative responses to disclosure and long-term impacts on healing and relationships. Survivors disclosed to informal and formal support persons and although many identified responses as positive or negative, some also experienced mixed responses. Survivors identified perceived long-term impacts on healing, interpersonal relationships, and social justice. Our findings suggest disclosures are a critical point for potential intervention after sexual violence. It is through the disclosure process that survivors can be supported and empowered to connect with others and move further along in their journey towards healing and recovery. Public awareness and promotion of positive responses could be designed to reach children and youth, so that the next generation is equipped with the tools to support each other in difficult times, particularly in the aftermath of sexual violence.

Evidence-based interventions to prevent child maltreatment among individuals and families are being implemented across wide areas of the U.S. Often focused on high-risk families such as teenage parents, single parents, or families living in poverty, these approaches are typically focused on giving parents skills, knowledge, and sometimes assistance with multiple needs that enable them to safely parent their young children. This chapter describes a much newer area of inquiry, that is how community-level approaches to child maltreatment prevention, typically evaluated on their ability to both change environments and to improve population rates of maltreatment, can augment these individual and family-focused efforts. We describe the development of these interventions and how it follows an emerging body of research on both neighborhood structural factors such as poverty and segregation, and potentially modifiable social processes, such as collective efficacy, each of which are associated with fluctuations in maltreatment rates in expected directions. A number of existing community-level prevention programs will be described. We will discuss different definitions of community-level programs for child maltreatment prevention; strategies for building relationships with communities; working with culturally diverse communities; overcoming barriers to implementation; and planning for sustainability. Recommendations for moving community-level child maltreatment programs forward are provided.

Maltreatment of children continues to be a major public health concern, with high social, economic and health burdens. Rates vary by a number of factors that can be categorized into different levels of the social ecology. Research and theory in this field point to the importance of community-level factors that can contribute to either risk or prevention of child maltreatment. The COVID-19 pandemic context creates additional risks and concerns related to child maltreatment and exacerbates risk factors that existed before: e.g., families and communities are in much worsened states of poverty, unemployment, and food insecurity; losses and grief are affecting mental health; and limitations and safety concerns are affecting in-person child protection work and more. Central to recovery from this pandemic will be the mobilization of community-level resources and the building back up of the social fabric that can support vulnerable children and caregivers. Key to this mobilization will be a better intersectional understanding of structural inequities in the child welfare system and in our communities. Efforts to dismantle structural biases and discrimination are critical to provide safety and support for families and vital for effective child maltreatment prevention. In this context, we discuss the state of the science of community-level prevention of childhood maltreatment, highlighting evidence-based community-level prevention programs and how these types of efforts may be impacted by the current COVID-19 global pandemic.

This study explores the role of family partners, peer professionals with lived experiences of raising a child with behavioral health needs, and their value in primary and community-care based mental health services for young children aged 0-8 years. Interviews and focus groups were conducted with staff, leadership, and caregiver participants (n = 38) from two early childhood mental health programs and analyzed using thematic analysis. Five interdependent themes emerged: (1) the centrality of lived experience to the family partner role; (2) the importance of the family partner in family engagement and relationship building; (3) the value added by the family partner in navigating systems; (4) the ability of the family partner to build skills and empower caregivers; (5) the role of the family partner in alleviating caregiver stress and other mental health concerns. Adapting and expanding the role of family partners will improve effective mental health care for children and their caregivers.

OBJECTIVE:Limited research exists on the impact of type and number of traumatic events on the incidence of suicide ideation and attempts (suicidality) among adolescents in low/middle income countries where violence is common. METHOD:We estimated prospective associations of 7 types of events on the new occurrence of suicidality from a follow-up conducted in 2013 (n = 1071; ages 19-26) of the original Mexican Adolescent Mental Health Survey conducted in 2005 (ages 12-17), by using Hazard Ratios (HR) estimates. RESULTS:For new onset of suicide ideation, those reporting "Ever raped or sexually assaulted" had the highest adjusted HR (3.8), followed by "Ever other traumatic event" (HR = 1.9), "Ever committed or witnessed violence" (HR = 1.7) and "Beaten as a child or witnessed physical fights at home" (HR = 1.5). For suicide attempt, those reporting "Ever beaten up by spouse, partner, someone else, mugged with a weapon, or stalked" (HR = 3.8) and "Ever other traumatic event" (HR = 2.0) had the higher hazards. Compared to those without a traumatic event, increased hazards of ideation and attempt were found for those reporting a greater number of types of events. CONCLUSIONS:Our sample is representative of the largest metropolitan area in Mexico but does not include other cities or age groups that may differ in risk factors. Traumatic events that happened in the eight years between waves are not considered. Traumatic events increased the risk of suicidality, independent of common mental disorders. Identifying and addressing these events in clinical settings may therefore be important for preventing suicide in this population.

Objectives: Previous research has indicated that area-level income inequality is associated with increased risk in alcohol consumption. However, few studies have been conducted among adolescents living within smaller area units, such as neighborhoods. We investigated whether neighborhood income inequality is associated with alcohol consumption among adolescents. Methods: We analyzed cross-sectional data from a sample of 1878 adolescents living in 38 neighborhoods participating in the 2008 Boston Youth Survey. Multilevel logistic regression modeling was used to determine the role of neighborhood income inequality and the odds for alcohol consumption and to determine if social cohesion and depressive symptoms were mediators. Results: In comparison to the first tertile of income inequality, or the most equal neighborhood, adolescent participants living in the second tertile (AOR = 1.20, 95% CI: 0.89, 1.61) and third tertile (AOR = 1.44, 95% CI: 1.06, 1.96) were more likely to have consumed alcohol in the last 30 days. Social cohesion and depressive symptoms were not observed to mediate this relationship. Conclusions: Findings indicate that the distribution of incomes within urban areas may be related to alcohol consumption among adolescents. To prevent alcohol consumption, public health practitioners should prioritize prevention efforts for adolescents living in neighborhoods with large gaps between rich and poor.

Vicarious trauma (VT) is the witnessing of, or learning about, another individual's traumatic experience, evoking an empathic response. VT, and associated conditions such as vicarious traumatization and secondary traumatic stress, is widespread among first responders (i.e., firefighters, police, and Emergency medical technicians [EMTs]) and victim assistance providers. VT can have damaging impacts on the physical and mental health of those exposed and leads to individual, organizational, and societal burdens. Strategies exist to address help organizations and individuals prevent negative impacts of VT; however, change agents-or individuals working to make a change in an organization-may face challenges in enacting these changes due to organizational barriers and cultural issues. This qualitative study examines data from first responders and victim service providers undergoing a process of changing their organization's response to VT. Interview and focus group data were gathered from 47 change agents within 15 diverse agencies. Results of thematic analysis showed that the nature of VT, namely, its intermittency, as well as administrative hurdles, made it challenging to maintain momentum for change. Recommendations for researchers and change agents within these agencies include following evidence-based organizational improvement processes and motivating administrators and workers to commit to making the change.