Over 50% of the 21 million veterans in the U.S. with behavioral health challenges are not having their needs met due to stigma and other barriers to care. Resiliency-based models focused on strengthening protective factors to help individuals adapt to adversity in community-based settings, that can be delivered by trained lay persons, are emerging approaches to help address this issue. This longitudinal pilot study evaluated the impact of one such evidenced-based intervention, the Community Resiliency Model (CRM), on veterans’ behavioral health and daily functioning. A sample of 46 English-speaking, ethnically diverse veterans were recruited for this study. Repeated measure analyses showed that CRM skills significantly decreased distress and increased well-being. We also found strong short-term results for measures of daily functioning with a significant longer-term impact on participants’ ability to control their feelings of being ‘amped up’. Most (82%) participants maintained and continued to use the CRM skills daily to weekly and had very positive reactions to the program. Across our analyses, the results of this pilot study suggest that providing CRM trainings to veterans is a feasible, efficacious, and well-received approach to help address much-needed veteran behavioral health.

Complex emergencies and disasters often result in a cascade of human suffering, which expose survivors to multiple traumatic situations and have a sizeable mental health impact. If available, most trauma treatments concentrate on addressing the cognitive or psychological aspects of trauma, which lacks the biological component of trauma that is central to human resiliency and wellness. The Community Resiliency Model (CRM) was created to increase mental health resources in underserved communities with complex trauma histories by teaching individuals to regulate their nervous system. Sierra Leone, one of the world’s poorest countries has a traumatic history of a 15-year civil war, frequent floods, and the 2014 Ebola outbreak. In the context of a lack of resources and ever-present stigma, many experience negative mental health with an estimated treatment gap of 98%. Our study set out to determine the immediate and six months effectiveness of a CRM intervention for Sierra Leonean community members in the aftermath of Ebola. Results indicated significant improved depression, anxiety, PTSD symptoms, and resiliency post intervention, which were mostly maintained 6-months later. These findings suggest CRM may be an effective way to address mental health issues that arise after disasters in low resourced settings.

This chapter describes the research on the Community Resiliency Model (CRM) and the Trauma Resiliency Model (TRM). A systematic approach to designing CRM research to expand its evidence base is described. The published research on CRM is discussed at length, and the beginning of evidence-based practice, both domestically and internationally, is considered.

This chapter describes how the Trauma Resiliency Model (TRM) and the Community Resiliency Model (CRM) can be used to help children who have experienced trauma. Children and adolescents exposed to trauma are at risk for developing long-term behavioral, health, and social problems. Research is described that examines the effects of trauma on the brain and how childhood maltreatment during early development can physically alter the biological structure and functioning of the brain, resulting in lasting behavioral and physical health problems across the lifespan. This chapter highlights how TRM and CRM are excellent approaches for implementing primary, secondary, and tertiary prevention programs within school and community settings. Child development and attachment are described in relation to using TRM/CRM.

This study tested the usability of a non-stigmatizing community-based trauma intervention delivered by trained community members. The Community Resiliency Model (CRM) was taught to a high-crime, low-income community designated as a Mental Health Provider Shortage Area (19 MPSA score). Five groups of Latino, African-American, LGBTQ, Asian Pacific Islander, and Veteran participants (N-57) with a history of complex/cumulative traumas and untreated posttraumatic stress undertook a five-day 40-h CRM training with master trainers. Measures included Treatment Relevance, Use and Satisfaction (TRUSS), Brief CRM Questionnaire (Brief CRM), and Symptom Questionnaire (SQ). Participant preparedness to teach CRM to others was high (98%) and sustained at the 3–6 months follow-up with 93% reporting a daily use. Pre-to post comparison analyses showed a significant decrease in distress indicators and increase in wellbeing indicators. CRM's high usability holds promise for a broader, low cost and sustainable implementation in traumatized and under-resourced communities.

Changes in the adolescent brain underlie the development of executive functions (EFs) after the onset of puberty; however, adolescents that engage in deliberate self-harm (DSH) have impaired EFs in the areas of inhibition, emotion regulation, shifting, and interpersonal functioning. On the other hand, dialectical behavior therapy (DBT) has been shown to be effective in treating adolescents with DSH. Moreover, the DBT skills of mindfulness, emotion regulation, distress tolerance, interpersonal effectiveness, and “walking the middle path” are suited to treat these adolescents with impaired EFs. This single group pre-post study examined changes in adolescents’ EFs who were enrolled in DBT. Ninety-three adolescents from a 16-week DBT program for DSH were administered the Behavior Rating Inventory of Executive Function-Self Report (BRIEF-SR) at pre-treatment and post-treatment. Adolescents improved from the elevated to non-clinical range on the Emotional Control, Shifting, and Monitor scales in addition to the Global Executive Composite of the BRIEF-SR. Significant effects for funding type on shifting, interpersonal functioning, and overall EF were observed while a significant effect for previous history of psychiatric hospitalizations was observed for emotion regulation. DBT appears to be effective for improving the EFs of adolescents with DSH and for specific subgroups of this population. Knowledge of these adolescents’ profile of EFs will assist clinicians in determining the type and level of intervention with DBT in order to shape positive behaviors during this important period of brain development.

The current review examines conceptual and methodological issues related to the use of dialectical behavior therapy for adolescents (DBT-A) in treating youth who engage in deliberate self-harm. A comprehensive review of the literature identified six studies appropriate for the review. Results indicated several inconsistencies and limitations across studies including the mixing of various forms of self-harm; variations in diagnostic inclusion/exclusion criteria, insufficient use of standardized self-harm outcome measures, variable lengths and intensity of provided treatment, and inadequate attention paid to DBT adherence. Each of these areas is reviewed along with a discussion of ways to improve the quality of future research.

Within the past two decades, few studies have examined outcomes of acute psychiatric hospitalization among children, demonstrating change in emotional and behavioral functioning. A secondary analysis of pretest/posttest data collected on 36 children was conducted, using the Target Symptom Rating (TSR). The TSR is a 13-item measure with two subscales-Emotional Problems and Behavioral Problems and was designed for evaluation of outcome among children and adolescents in acute inpatient psychiatric settings. Results of this study, its limitations, and the barriers encountered in the implementation of the TSR scale as part of routine clinical practice are discussed.

This study examined risk and determinants of rehospitalization of children and adolescents (n = 186) following a first psychiatric hospitalization. It specifically examined the role of post-discharge services. Data were collected for a 30-month follow-up period through structured telephone interviews with caregivers and case record abstractions. 43% of youth experienced readmissions during the follow-up period. Risk of rehospitalization was highest during the first 30 days following discharge and remained elevated for 3 months. 72% of youth received 284 post-discharge services during the follow-up period, which significantly reduced the risk of rehospitalization. Longer first hospitalizations and a higher risk score at admission increased risk.