Gender Differences in the Effects of Community Violence on Mental Health Outcomes in a Sample of Low-Income Youth Receiving Psychiatric Care

Previous research suggests that community violence impacts mental health outcomes, but much of this research has not (a) distinguished between different types of community violence, (b) examined gender differences, and (c) focused on youth living in urban poverty. The current study addresses these questions. Participants were 306 youth (23 % girls) and one parent/guardian receiving outpatient psychiatric services for disruptive behavior disorders in a large urban city. Youth and parents reported on youth’s experience of different types of community violence (being a direct victim, hearing reports, and witnessing violence), and whether violence was directed toward a stranger or familiar. Outcomes included youth externalizing, internalizing, and posttraumatic stress symptoms assessed via parent and youth reports. Being a direct victim of violence accords risk for all mental health outcomes similarly for both boys and girls. However, gender differences emerged with respect to indirect violence, such that girls who hear reports of violence against people they know are at increased risk for all assessed mental health outcomes, and girls who witness violence against familiars are at increased risk for externalizing mental health symptoms in particular. There are gender differences in violence-related mental health etiology, with implications for intervention assessment and design.     

Engaging high risk families in community based intervention services

Involving high risk families in community based intervention services constitutes a major challenge facing service delivery in the fields of mental health and substance abuse. Mental health and substance abuse programs typically experience high rates of failure to enroll families in services, as well as high rates of drop-outs from treatment. With family-based intervention programs, those involving all the members of the family or household participation by the entire family is a key to having a successful program. The NIDA funded Youth Support Project tests such a home and family based Family Empowerment Intervention in a randomized field trial which targets families of juvenile offenders. This intervention is delivered three times a week by paraprofessionals who are supervised by a licensed clinician. We discuss the guiding principles and success of our enrollment activities and discuss their implications for other family-based services.     

Family-level impact of the CHAMP Family Program: a community collaborative effort to support urban families and reduce youth HIV risk exposure

This article presents family-level results from an ongoing study examining the impact of the CHAMP (Chicago HIV prevention and Adolescent Mental health Project) Family Program, a family-based HIV preventative intervention meant to reduce the amount of time spent in situations of sexual possibility and delay initiation of sexual activity for urban youth in the 4th and 5th grades living in neighborhoods with high rates of HIV infection. The CHAMP Family Program has been developed, delivered, and overseen by a collaborative partnership, consisting of community parents, school staff, community-based agency representatives, and university-based researchers. Design of the program was informed by input from this collaborative partnership, child developmental theory of sexual risk, and empirical data gathered from the targeted community. This article presents findings that suggest CHAMP Family Program impact on family communication, family decision-making, and family-level influences hypothesized to be related to later adolescent HIV risk. Implications for future family-based HIV prevention research are discussed here.     

Youth Exposed to Violence: Stability, Co-occurrence, and Context

With considerable literature establishing how separate types of violence disrupt the lives of children, there is emerging interest in examining violence across multiple interpersonal domains. This article examines four commonly occurring and frequently researched domains of violence exposure: marital physical aggression, mother-to-youth aggression, father-to-youth aggression, and community violence. A community-based sample of 103 parents and youth provided three waves of data at annual intervals beginning when the youth were aged 9–10. We explored stability of exposure, co-occurrence across different types of violence exposure, and associations with co-occurring risk factors. Approximately 30–45% of youth reported intermittent exposure over the 3 years. In addition to overlap among types of violence exposure within the family, we found overlap between parent-to-youth aggression and community violence, an association that was exacerbated in families where fathers reported high levels of global distress symptoms. Mother-to-youth, father-to-youth, and community violence related to youth behavior problems beyond the contextual risk factors of low income, stressful life events, and parents’ global distress symptoms. These results highlight the importance of examining violence longitudinally, across multiple types, and with attention to contextual factors.     

Addressing Family Violence Within Juvenile Courts

Summary

Whether as overt or underlying issues, family violence is prevalent within juvenile court caseloads, yet often is not identified within intake and disposition. Focusing on juvenile victimization of parents, and to a lesser extent teen dating partners, this article discusses model programs emerging in juvenile courts specifically addressing these issues. A comparative analysis of the drug court trend is explored in the context of its applicability for specialized family violence applications in the Juvenile Court. An overview of the King County (Washington) Juvenile Court's Step-Up Program and the Santa Clara County (California) Juvenile Court's Family Violence program is offered, followed by the process by which the Travis County (Texas) Juvenile Court has implemented a program similar to these models. Effective interventions with violent families must be informed by the domestic violence community's treatment expertise, building on the paradigm of youth resilience.     

Urban youth disruptive behavioral difficulties: exploring association with parenting and gender

The current study will examine behavioral difficulties among a sample of African American urban youth who were exposed to violence. Possible gender differences in disruptive behavioral difficulties, as well as possible associations between parental practices, family relationships, and youth disruptive behavioral difficulties are examined. A secondary data analysis from baseline data for 125 African American urban mothers and their children collected as part of a large-scale, urban, family-based, HIV prevention research study was analyzed. Findings reveal that externalizing behavioral problems in youth are associated with exposure to violence. Girls displayed significantly higher levels of externalizing behavioral difficulties than boys. Mothers' parenting practices and family relationships were associated with youths' externalizing behavior problems. Implications for interventions to reduce youths' exposure to violence and to develop gender sensitive interventions for youth and supportive interventions for their parents are discussed.     

Uplifting the Family: African American Parents’ Ideas of How to Integrate Religion into Family Health Programming

Religion has been reported as a strong cultural-historical and protective factor in the African American community, particularly for African American youth regarding risky behavior prevention. Despite the historical and scholarly evidence of its utility, the opportunities for using religion and the Black Church in supporting the mental, emotional, and physical health of Black youth have not been fulfilled. Furthermore, partnering with the community to conduct research and program development increases the likelihood of use and success. The purpose of this study was to partner with the community and learn and conceptualize how to integrate or use religion in a family health program. Seven focus groups were conducted with African American parents/guardians regarding how a family health program could use religion to enhance the mental and physical wellbeing of Black families. A community sample of parents and guardians conveyed religious/spiritual values that a program should adopt and teach to participants (particularly parents) and ways that a program could use religion and the Black Church to function and succeed. These values include respect, love, prayer, fellowship/community, physical health, Scripture, faith, and empathy/understanding. Participants further provided specifics regarding how such programming might be implemented and offered real world implications for the development of religious family health planning. Parents/guardians indicated that religious values and methods should be used together to bolster family health, prevent risky behavior in youth, and support community functioning.     

Community Violence and Youth: Affect, Behavior, Substance Use, and Academics

Community violence is recognized as a major public health problem (WHO, World Report on Violence and Health, 2002) that Americans increasingly understand has adverse implications beyond inner-cities. However, the majority of research on chronic community violence exposure focuses on ethnic minority, impoverished, and/or crime-ridden communities while treatment and prevention focuses on the perpetrators of the violence, not on the youth who are its direct or indirect victims. School-based treatment and preventive interventions are needed for children at elevated risk for exposure to community violence. In preparation, a longitudinal, community epidemiological study, The Multiple Opportunities to Reach Excellence (MORE) Project, is being fielded to address some of the methodological weaknesses presented in previous studies. This study was designed to better understand the impact of children’s chronic exposure to community violence on their emotional, behavioral, substance use, and academic functioning with an overarching goal to identify malleable risk and protective factors which can be targeted in preventive and intervention programs. This paper describes the MORE Project, its conceptual underpinnings, goals, and methodology, as well as implications for treatment and preventive interventions and future research.     

The Family Peace Project

Summary

Intimate partner violence-assault by a spouse, ex-spouse, intimate friend or ex-friend-is the most common cause of injury for women and a serious public health problem. As a result, the American Medical Association has recognized physicians' ethical obligation to diagnose and treat partner violence, and called for new models of training. In this article, we review literature on the health care system's response to domestic violence. We then describe the Family Peace Project, a community oriented model for training health care professionals to identify, treat and prevent partner violence in primary health care settings. This training program provides knowledge, clinical skills and a sense of professional empowerment. Unique features of this program include: involvement of community mentors (survivors of family violence) as program faculty; training in specific clinical skills and protocols for screening, assessment and intervention; a hands-on assessment of community resources; coinmunity service; and, creation of an award winning web site to promote dissemination of the training program.     

The Role of Maternal Acceptance in the Relation Between Community Violence Exposure and Child Functioning

Children in the United States are exposed to considerable community violence that has been linked to child functioning. However, not all those exposed, experience negative outcomes. Recent research has focused on factors that “buffer” or protect children from negative consequences of violence exposure. The purpose of this investigation was to examine the potential buffering or moderating role of maternal acceptance in the relationship between community violence exposure and internalizing and externalizing problems. Subjects were 268 urban African American first graders. Community violence exposure was significantly related to symptoms of post-traumatic stress, but did not correlate with either internalizing or externalizing problems for all children, after control for demographics, maternal mental health, and general life stress. However, children's perceptions of maternal acceptance moderated the relationship between violence exposure and internalizing and externalizing problems which included being withdrawn, anxious-depressed, and demonstrating delinquent behavior. Children with the lowest levels of self-reported maternal acceptance were most impacted by community violence. In this sample of urban first graders, low levels of maternal acceptance placed children at greater risk for adverse outcomes associated with community violence exposure compared to moderate and high levels of maternal acceptance.     

Family Intervention to Prevent Depression and Substance Use Among Adolescents of Depressed Parents

Parental depression places offspring at elevated risk for multiple, co-occurring problems. The purpose of this study was to develop and preliminarily evaluate Project Hope, a family intervention for the prevention of both depression and substance use among adolescent-aged children (M?=?13.9?years) of depressed parents. The program was created by blending two empirically supported interventions: one for depression and another for substance use. Thirty families were randomly assigned to either Project Hope (n?=?16) or a wait-list control condition (n?=?14). Pretests, posttests (n?=?29), and 5-month follow-ups (n?=?28) were conducted separately with parents and youth via phone interviews. Questions asked about the family depression experience, family interactions, family management, coping, adolescent substance use beliefs and refusal skills, adolescent depression, and adolescent substance use. Project Hope was fully developed, manualized, and implemented with a small sample of targeted families. Engagement in the program was relatively high. Preliminary outcome analyses were conducted using 2 (Group) ×3 (Time) analyses of covariance. Results provided some evidence for significant improvements among intervention compared to control participants in indicators of the family depression experience, family management, and coping, and a statistically significant decrease from pretest to posttest in alcohol quantity for intervention compared to control youth. Next steps for this program of research are discussed.     

Universal Prevention Exposure as a Moderator of the Community Context: Findings from the PROSPER Project

This study examined how participation in a universal family skills‐building program may interact with community risks and resources to produce youth outcomes. Prior research has noted community‐level variability in risk and protective factors, but thus far no study has examined the role that participation on a community‐wide intervention may play in moderating the effects of community risks or resources. The study included 14 communities (seven in Iowa, seven in Pennsylvania) that implemented a family focused evidence‐based program as part of the PROSPER project. Community level variables included both risk factors (percent of low income families, the availability of alcohol and tobacco, norms regarding adolescent substance use, incidence of drug‐related crimes) and community resources (proactive school leadership, availability of youth‐serving organizations, and student involvement in youth activities). The proximal youth and family outcomes included youth perceptions of their parents’ management skills, parent–child activities, and family cohesion. Results indicated that the Strengthening Families Program:10–14 may have moderated the impact of the community risks and resources on community‐level youth outcomes; risk levels meaningfully associated with community‐level change in program participants, though these results varied somewhat by outcome. Generally, higher levels of resources also meaningfully associated with more positive change after participating in the family‐focused intervention. These results suggest that the effect of some evidence‐based programs may be even stronger in some communities than others; more research in this area is needed.     

‘Someone to talk to who'll listen’: addressing the psychosocial needs of children and families

The paper presents the Lewisham Community Child and Family Service (LCCFS), a community‐based intervention providing psychosocial help for children, young people, parents and families. The service is focused on early intervention, prevention and promotion in the improvement of local health. It works under a service framework based on inter‐agency collaboration, and a counselling model based on community and interpersonal partnerships, grounded in personal construct theory (Kelly, 1955). The policy demands and local need for accessible and acceptable mental health are discussed, and quantitative and qualitative findings of the needs assessment preceding the establishment of the LCCFS are presented, supporting the need for community mental health provision. The feasibility for the LCCFS to reconcile and meet the policy demands and the needs of parents with respect to child psychosocial help and services are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

Risk Factors for Community Violence Exposure in Adolescence

Community violence is recognized a significant public health problem. However, only a paucity of research has examined risk factors for community violence exposure across domains relevant to adolescents or using longitudinal data. This study examined youth aggressive behavior in relation to community violence exposure among a community epidemiologically defined sample of 582 (45% female) urban adolescents. Internalizing behaviors, deviant peer affiliation, and parental monitoring were examined as moderators of the association between aggressive behavior and exposure to community violence. For males with aggressive behavior problems and deviant peer affiliation or low parental monitoring, co-occurring anxiety symptoms protected against subsequent witnessing community violence. In contrast, males with aggressive behavior problems and co-occurring depressive symptoms were at increased risk for witnessing community violence. Implications of the findings for preventive interventions and future research are discussed.     

Does community violence exposure moderate the associations between maternal spanking and early child behavior problems?

A robust research literature links parental spanking with negative behavioral outcomes for children, however, it remains unclear whether conditions in the community may moderate the associations between spanking and behavior problems in early childhood. In the current study, we examined whether community violence exposure moderated the associations of maternal spanking with externalizing and internalizing behavior problems of young children. The sample used in this study was urban families and their children ages 3–5 (n = 2,472). We used fixed effects regression models, which yield stronger statistical control for baseline behavior problems, selection bias, and omitted variables bias. Mother's spanking was associated with elevated levels of both externalizing (β = .037, p < .001) and internalizing (β = .016, p < .001) behavior problems. Community violence exposure also predicted higher levels of externalizing (β = .071, p < .01) and internalizing (β = .043, p < .05) behavior problems. Community violence exposure did not moderate the associations between maternal spanking and behavior problems. Professionals working with families should promote the use of nonphysical disciplinary practices, regardless of the level of violence and crime in the community in which the family resides.     

A Randomized Controlled Trial of the Impact of a Family-Based Adolescent Depression Intervention on both Youth and Parent Mental Health Outcomes

This paper presents findings from a multi-centre, double-blind, randomized controlled trial that tested the hypothesis that parent and youth mental health improvements would be superior in a family-based intervention for adolescent depression (BEST MOOD) compared to a treatment-as-usual supportive parenting program (PAST). Eligible participants were families with a young person aged between 12 and 18 years who met diagnostic criteria for a depressive disorder (major, minor or dysthymic). Participating families (N = 64; 73.4% of youth were female) were recruited in Victoria, Australia and allocated to treatment condition using a block randomization procedure (parallel design) with two levels of blinding. This paper reports on the trial’s secondary outcomes on youth and parent mental health. General linear mixed models were used to examine the longitudinal effect of treatment group on outcome. Data were analyzed according to intention-to-treat; 31 families were analyzed in BEST MOOD, and 33 families in PAST. Parents in the BEST MOOD group experienced significantly greater reductions in stress and depressive symptoms than parents in the PAST group at 3-month follow-up. A greater reduction in parental anxiety was observed in the BEST MOOD group (d = 0.35) compared with PAST (d = 0.02), although the between-group difference was not significant. Both groups of youth showed similar levels of improvement in depressive symptoms at post-treatment (d = 0.83 and 0.80 respectively), which were largely sustained at a 3-month follow-up. The family-based BEST MOOD intervention appeared superior to treatment-as-usual (PAST) in demonstrating greater reductions in parental stress and depression. Both interventions produced large reductions in youth depressive symptoms.     

Developing a family-based depression prevention program in urban community mental health clinics: a qualitative investigation

Extensive research documents that children of depressed mothers are at a significantly higher risk for developing a variety of socioemotional difficulties than children of nondepressed mothers. Yet, little prevention research has been conducted for this population, and low-income, minority, and urban families are rarely included. To address this deficit, we are developing the Protecting Families Program (PFP), a family-based multicomponent depression prevention program for mothers in treatment at urban community mental health agencies and their school-aged children. To inform intervention development and begin relationship building with the agencies, patient and staff focus groups were conducted in the participating agencies. Eighteen mothers with depression participated, and eight major themes were identified: (1) depression symptoms, (2) generational legacy, (3) parenting difficulties, (4) child problems, (5) social support, (6) stressful life events, (7) therapy and other helpful activities, and (8) desired treatment. In the focus groups with 10 mental health providers, the five major themes identified were parenting difficulties, lack of social support, life stress, current mental health practices, and intervention development. The findings support the multicomponent design of PFP, which focuses on increasing knowledge of depression, enhancing social support, and improving parenting skills. The study helped clarify many of the challenges of conducting research in a community mental health system.     

Oppression and empowerment: perceptions of violence among urban youth

Youth violence in the United States has emerged as a major concern for communities, policymakers and community researchers. This paper reports on the efforts of a child mental health clinic to build a community consensus around addressing violence that affects youth and all members of the community. We describe and give case examples regarding our approach to acquiring the perspectives of the community, particularly that of youth, discuss key themes and implications that emerged from our work, and offer preliminary recommendations for designing a youth violence prevention initiative in a disenfranchised community. Copyright © 2007 John Wiley & Sons, Ltd.