Evaluation of a Multi-Phase Trauma-Focused Intervention with Latino Youth

Keywords: Post Traumatic Stress Disorder, trauma-informed treatment, Latino youth, mental health

Abstract

This pilot study examined the effectiveness of a multi-phase trauma-informed intervention with 24 trauma-exposed Latino youth. Treatment included a somatic-based intervention to target physiological hyperarousal symptoms and a sensory/cognitive-based trauma-focused intervention targeting stabilization of the trauma experience. Twenty-four participants completed several measures for mental health symptomatology and psychosocial functioning at baseline, at the conclusion of treatment, and at 3-month follow-up. Results of paired sample t-test analyses showed significant improvements in scores on measures for trauma, anxiety, depression, psychosocial functioning, and emotional dysregulation following 12 weeks of treatment when compared to baseline. Improvements were maintained at 3-month follow-up. This community-based intervention shows promise in helping Latino children who have experienced trauma. Research using randomized controlled designs with larger samples is suggested to further test the efficacy of this intervention.

 

Author Biographies

Anne S. J. Farina, Saint Louis University
Anne Farina, MSW, LCSW is a doctoral student in the School of Social Work at Saint Louis University.
Michael Mancini, Saint Louis University

Michael Mancini, PhD, MSW, is Associate Professor in the School of Social Work at Saint Louis University.

References

Alcántera, C., Casement, M. D., & Lewis-Fernández, R. (2013). Conditional risk for PTSD among Latinos: A systematic review of racial/ethnic differences and sociocultural explanations. Clinical Psychology Review, 33, 107-119. doi: https://doi.org/10.1016/j.cpr.2012.10.005
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(10), 1230-1236. doi: https://doi.org/10.1097/00004583-199910000-00011
Birman, D., & Chan, W. Y. (2008, May). Screening and assessing immigrant and refugee youth in school-based mental health programs. Washington DC: Center for Health and Health Care in Schools.
Boothroyd, R. A., & Armstrong, M. (2010). An examination of the psychometric properties of the Pediatric Symptom Checklist with children enrolled in Medicaid. Journal of Emotional and Behavioral Disorders, 18(2), 113-126. doi: https://doi.org/10.1177/1063426609337604
Buckner, J. C., Mezzacappa, E., & Beardslee, W. R. (2009). Self-regulation and its relations to adaptive functioning in low income youths. American Journal of Orthopsychiatry, 79(1), 19-30. doi: https://doi.org/10.1037/a0014796
Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M. Cloitre,…van der Kolk, B. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35, 390-398.
Corrigan, F. M., Fisher, J. J., & Nutt, D. J. (2010). Autonomic dysregulation and the window of tolerance model of the effects of complex emotional trauma. Journal of Psychopharmacology, 25(1), 17-25. doi: https://doi.org/10.1177/0269881109354930
Crockett, L. J., Randall, B. A., Shen, Y., Russell, S. T., & Driscoll, A. K. (2005). Measurement equivalence of the Center for Epidemiological Studies Depression Scale for Latino and Anglo adolescents: A national study. Journal of Consulting and Clinical Psychology, 73(1), 47-58. doi: https://doi.org/10.1037/0022-006X.73.1.47
Cuevas, C. A., Sabina, C., & Milloshi, R. (2012). Interpersonal victimization among a national sample of Latino women. Violence Against Women, 18(4), 377-403. doi: https://doi.org/10.1177/1077801212452413
Dettlaff, A. J., & Johnson, M. A. (2011). Child maltreatment dynamics among immigrant and U.S. born Latino children: Findings from the National Survey of Child and Adolescent Well-being (NSCAW). Children and Youth Services Review, 33, 936-944. doi: https://doi.org/10.1016/j.childyouth.2010.12.017
Dobal, E., Martínez, M., & Doménech-Llaberia, E. (2011). Evidencias de salidad psicométrica de la version en Castellano del Screen for Child Anxiety Related Emotional Disorders (SCARED) de 41 items. Ansiedad y Estrés, 17(2-3), 199-210.
Farina, A.S.J., & Silversmith, K. (2013). Somatic Soothing manual for clinicians. Unpublished manuscript.
Faulstich M. E., Carey M. P., Ruggiero L., Enyart, P., & Gresham, F. (1986). Assessment of depression in childhood and adolescence: An evaluation of the Center for Epidemiological Studies Depression Scale for Children (CES-DC). American Journal of Psychiatry 143(8), 1024-1027. doi: https://doi.org/10.1176/ajp.143.8.1024
Fortuna, L., Porche, M., & Alegria, M. (2008). Political violence, psychosocial trauma, and the context of mental health services among immigrant Latinos in the United States. Ethnicity & Health, 13, 435-463. doi: https://doi.org/10.1080/13557850701837286
Galea, S., Vlahov, D., Tracy, T., Hoover, D. R., Resnick, H., & Kilpatrick, D. (2004). Hispanic ethnicity and post-traumatic stress disorder after a disaster: Evidence from a general population survey after September 11, 2001. Annals of Epidemiology, 14, 520-531. doi: https://doi.org/10.1016/j.annepidem.2004.01.006
Gudiño, O. G., Lau, A. S., & Hough, R. L. (2008). Immigrant status, mental health need, and mental health service utilization among high-risk Hispanic and Asian Pacific Islander youth. Child & Youth Care Forum, 37, 139-153. doi: https://doi.org/10.1007/s10566-008-9056-4
Jellinek, M. S., Murphy, J. M., Robinson, J., Feins, A., Lamb, S., & Fenton, T. (1988). The Pediatric Symptom Checklist: Screening school-age children for psychosocial dysfunction. Journal of Pediatrics, 112, 201-209. doi: https://doi.org/10.1016/S0022-3476(88)80056-8
Kaltman, S., Green, B. L., Mete, M., Shara, N., & Miranda, J. (2010). Trauma, depression, and comorbid PTSD/depression in a community sample of Latina immigrants. Psychological Trauma: Theory, Research, Practice, and Policy, 2, 29-31. doi: https://doi.org/10.1037/a0018952
Lawson, D. M., & Quinn, J. (2013). Complex trauma in children and adolescents: Evidence-based practice in clinical settings. Journal of Clinical Psychology: In Session, 69(5), 497-509. doi: https://doi.org/10.1002/jclp.21990
Lefley, H. P., Scott, C. S., Liabre, M., & Hicks, D. (1993). Cultural beliefs about rape and victims response in three ethnic groups. American Journal of Orthopsychiatry, 64(4), 623-632. doi: https://doi.org/10.1037/h0079477
Lewis-Fernandez, R., Turner, J. B., Marshall, R., Turse, N., Neria, Y., & Dohrenwend, B. P. (2008). Elevated rates of current PTSD among Hispanic veterans in the NVVRS: True prevalence or methodological artifact? Journal of Traumatic Stress, 21, 123-132. doi: https://doi.org/10.1002/jts.20329
Marshall, G. N., Schell, T. L., & Miles, J. N. V. (2009). Ethnic differences in post-traumatic distress: Hispanics’ symptoms differ in kind and degree. Journal of Consulting and Clinical Psychology, 77(6), 1169-1178. doi: https://doi.org/10.1037/a0017721
Monga, S., Birmaher, B., Chiappetta, L., Brent, D., Kaufman, J., Bridge, J., & Cully, M. (2000). Screen for Child Anxiety-Related Emotional Disorders (SCARED): Convergent and divergent validity. Depression and Anxiety, 12(2), 85-91. doi: https://doi.org/10.1002/1520-6394(2000)12:2<85::AID-DA4>3.0.CO;2-2
Ogden, P, & Minton, K. (2000). Sensorimotor psychotherapy: One method for processing traumatic memory. Traumatology, 3(3), 149-173. doi: https://doi.org/10.1177/153476560000600302
Ogden, P., Pain, C., & Fisher, J. (2006). A sensorimotor approach to the treatment of trauma and dissociation. Psychiatry Clinics of North America, 29, 263-279. doi: https://doi.org/10.1016/j.psc.2005.10.012
Perry, B. D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical application of the Neurosequential Model of Therapeutics. Journal of Loss and Trauma, 14, 240-255. doi: https://doi.org/10.1080/15325020903004350
Pynoos, R. S., Rodriguez, N., Steinberg, A., Stuber, M., & Frederick, C. (1998). The UCLA posttraumatic stress reaction index for DSM-IV. Los Angeles: UCLA Trauma Psychiatry Program.
Raio, C. M., Orederu, T. A., Plazzolo, L., Shurick, A. A., & Phelps, E. A. (2013). Cognitive emotional regulation fails the stress test. Proceedings of the National Academy of Sciences, 110(37), 15139-15144. doi: https://doi.org/10.1073/pnas.1305706110
Rodriguez, N., Steinberg, A. S., Saltzman, W. S., & Pynoos, R. S. (2001). PTSD Index: psychometric analysis of the adolescent version. Symposium conducted at the Annual Meeting of the International Society for Traumatic Stress Studies, New Orleans: LA.
Rojas-Flores, L., Clements, M. L., Koo, J. H., & London, J. (2016). Trauma and psychological in Latino citizen children following parental detention and deportation. Psychological Trauma: Theory, Research, Practice, and Policy, 9(3), 352-361. doi: https://doi.org/10.1037/tra0000177
Rosenblum, G. D., & Taska, L. S. (2014). Self-defense training as clinical intervention for survivors of trauma. Violence Against Women, 20(3), 293-308. doi: https://doi.org/10.1177/1077801214526048
Sedlak, A. J., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., & Li, S. (2010). Fourth national incidence study of child abuse and neglect (NIS-4): Report to Congress. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families. Retrieved from https://www.acf.hhs.gov/sites/default/files/opre/nis4_report_congress_full_pdf_jan2010.pdf
Shaffer, D., Gould, M.S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., & Aluwawhlia, S. (1983). A children’s global assessment scale (CGAS). Archives of General Psychiatry, 40, 1228-1231.
Shaw, J. A., Lewis, J. E., Loeb, A., Rosado, J., & Rodriguez, R. A. (2001). A comparison of Hispanic and African-American sexually abused girls and their families. Child Abuse & Neglect, 25, 1363-1379. doi: https://doi.org/10.1016/S0145-2134(01)00272-1
Shields, A., & Cicchetti, D. (1997). Emotion regulation among school-age children: The development and validation of a new criterion q-sort scale. Developmental Psychology, 33(6), 906-916. doi: https://doi.org/10.1037/0012-1649.33.6.906
Steele, W., & Malchiodi, C. A. (2012). Trauma-informed practices with children and adolescents. New York: Routledge.
Steinberg, A. M., Brymer, M. J., Kim, S., Briggs, E. C., Ippen, C. G., Ostrowski, S. A., Gully, K. J., & Pynoos, R. S. (2013). Psychometric properties of the UCLA PTSD Reaction Index: Part I. Journal of Traumatic Stress, 26, 1-9. doi: https://doi.org/10.1002/jts.21780
Steinberg, A.M., Brymer, M.J., Decker, K.B., & Pynoos, R.S. (2004). The University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index. Current Psychiatry Reports, 6, 96-100.
U.S. Department of Health and Human Services, Administration on Children, Youth, and Families. (2015). Child Maltreatment 2015. Washington, D.C.: U.S. Government Printing Office. Retrieved from https://www.acf.hhs.gov/sites/default/files/cb/cm2015.pdf
van der Kolk, B. A. (1994). The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Harvard Review of Psychiatry, 1(5), 252-265. doi: https://doi.org/10.3109/10673229409017088
van der Kolk, B. A. (2006). Clinical implications of neuroscience research in PTSD. Annals of the New York Academy of Sciences, 1071, 277-293. doi: https://doi.org/10.1196/annals.1364.022
Warner, E., Koomar, J., Lary, B., & Cook, A. (2013). Can the body change the score? Application of sensory modulation principles in the treatment of traumatized adolescents in residential settings. Journal of Family Violence, 28(7), 729-738. doi: https://doi.org/10.1007/s10896-013-9535-8
Warner E., Koomar, J., & Westcott, A. (2009). Arousal regulation in traumatized children: Sensorimotor interventions [PowerPoint slides]. Retrieved from http://www.traumacenter.org/announcements/TConf.09_SMART_Handouts.pdf
Warner, E., Spinazzola, J., Westcott, A., Gunn, C., & Hodgdon, H. (2014). The body can change the score: Empirical support for somatic regulation in the treatment of traumatized adolescents. Journal of Child & Adolescent Trauma, 7, 237-246. doi: https://doi.org/10.1007/s40653-014-0030-z
Weissman, M. M., Orvaschel, H., & Padian, N. (1980). Children’s symptom and social functioning self-report scales. Comparison of mothers’ and children’s reports. The Journal of Nervous and Mental Disease, 168(12), 736-740. doi: https://doi.org/10.1097/00005053-198012000-00005
Wilbarger, P. (1984). Planning an adequate “sensory diet”--Application of sensory processing theory during the first year of life. Zero to Three, 5(1), 7-12.
Wolf, E. J. (2013). The Dissociative Subtype of PTSD: Rationale, evidence, and future directions. PTSD Research Quarterly, 24(4), 1-8.
Published
2017-09-24