Assessment and Intervention for PTSD in Children Exposed to Violence

Summary

Recent research has established that exposure to domestic violence is a major risk factor for posttraumatic stress disorder (PTSD) in children. However, one issue that has been relatively neglected in research conducted to date concerns developmental differences: both in the expression of PTSD symptoms across childhood and adolescence, and in the techniques appropriate for assessing and intervening with PTSD in children at different ages. The available literature is reviewed concerning the conceptualization, measurement, and treatment of PTSD in children, with special attention to the case of children of battered women. Guidelines are provided for developmentally sensitive approaches to assessment and treatment.     

Threat Vigilance in Child Witnesses of Domestic Violence: A Pilot Study Utilizing the Ambiguous Situations Paradigm

Research has found that children exposed to family violence exhibit higher rates of maladjustment. We review relevant literature on family violence, marital conflict, and cognitive factors implicated in child behaviour problems. A bias toward perceiving threat in ambiguous contexts has been identified as one factor mediating both aggressive and anxious behaviour disorders. We conducted a study utilizing the ambiguous situations paradigm to assess whether children exposed to violent spousal conflict were more likely than children not exposed to violence (divided into children with an externalizing behaviour disorder and non-clinic children) to perceive threat in two classes of ambiguous situations: Peer and Inter-Parental. The results indicated that children exposed to violent spousal conflict perceived more threat in parental situations than either of the other two groups. A number of considerations were taken into account given the exploratory nature of the study, particularly sample limitations. We conclude with suggestions for improvements to the research design and the further relevance of exploring cognitive factors involved in the adjustment of children from backgrounds of violence.     

Intervention for Children Exposed to Interparental Violence (IPV): Assessment of Needs and Research Priorities

In this paper we review the development of interventions for children who have been exposed to interparental violence (IPV), assess current needs in the evaluation of interventions, and provide suggestions for research priorities in this area. Interventions for negative outcomes associated with exposure to IPV only recently have been carefully designed and evaluated, thus knowledge regarding program effectiveness is minimal. Three of the most comprehensive interventions that have been evaluated are presented. Each has demonstrated effectiveness, and focuses on children with different levels of symptoms and distress. However, many questions remain regarding which interventions are beneficial for diverse children with different kinds and intensities of problems. A number of research priorities and suggestions for further improvements in the evaluation of effectiveness of interventions are identified.     

Behavioral Assessment in the Schools:

This article discusses behavioral assessment as a way of obtaining and evaluating information used to individualize programming for special needs pupils. Behavioral assessment offers a range of techniques for gathering and for evaluating information. Strategies for obtaining information that are described are self-monitoring, direct observation, permanent product review, and retrospective ratings using behavior checklists. Strategies for evaluating information that are discussed are single-case research designs and social validation. These strategies assist in identifying pupil problems and selecting interventions, evaluating student progress, assessing treatment fidelity, determining causality, and revising individualized programs by providing a broad base for decision-making.     

Creating Safer and More Nurturing Schools: Expanding the Capacity of Schools in the Era of Future National Reform

ABSTRACT

Positive academic performance is a strong indicator of subsequent positive life course outcomes (e.g., employment) as well as underrepresentation in psychiatric populations, drug use, school dropout, and subsequent legal trouble (A. Farn & J. Adams, 2016). As such, helping all children to be successful in school is a top priority for parents, educators, and politicians alike. However, schools are challenged by an increasing demand to meet children's health and metal health needs in order for them to benefit from, and progress in, their educational experience. Public concerns regarding violent acts on school property have highlighted the need to address student and teacher safety. The authors provide recommendations for school psychologists regarding promising practices that respond to national initiatives to prevent school violence, increase access to health and mental health care, and enhance equity among students.     

Resistance to Violence Prevention Interventions in Schools: Barriers and Solutions

Studies of the prevalence and impact of aggression among school-age children and adolescents document the pervasiveness of bully-victim problems and indicate clear linkages between bully-victim problems, psychological distress, and, in rare instances, lethal attacks on perceived tormentors or towards the self. Evidence is slowly accumulating to show how well-conceived school-based strategies can be effective in addressing bully-victim problems—if implemented and sustained. However, anecdotal evidence suggests many comprehensive school-based initiatives suffer from incomplete implementation, resulting in limited effectiveness. We propose that multiple factors nested within different levels of social ecological complexity (e.g., individual, school, community, and culture) limit the widespread use of schoolwide approaches to reducing bully–victim–bystander problems. Challenges arise at each of these levels and can potentially thwart efforts to produce meaningful changes in the problems of peer victimization in and around school. Drawing from efforts to implement and evaluate bully–victim–bystander programs, we describe a core set of potential barriers at each ecological level and offer possible strategies for action.     

A Mixed Methods Study of the Stages of Implementation for an Evidence-Based Trauma Intervention in Schools

A mixed methods study was conducted to examine the implementation process of 26 urban school-based mental health clinics that took part in a training and implementation support program for an evidence-based school trauma intervention. Implementation process was observed using the Stages of Implementation Completion (SIC) measure. Qualitative interviews were conducted with clinic leaders in order to gain insight into clinic processes related to the SIC. Results showed that almost all of the clinics engaged in some activities related to pre-implementation (engagement, feasibility, and readiness), but only 31% of the sites formally started delivering the program to youth. Completing more pre-implementation activities, particularly those related to readiness, predicted program start-up. Qualitative analysis comparing those that implemented the program to those that did not revealed critical differences in decision-making processes, leadership strategies, and the presence of local champions for the program. This study documented the patterns of clinic behavior that occurs as part of large-scale training efforts, suggests some unique challenges that occur in schools, and highlights the importance of engaging in particular implementation activities (i.e., readiness planning, stakeholder consensus and planning meetings) as part of program start-up. Findings indicate that pre-implementation and readiness-related consultation should be employed as part of broad-scale implementation and training efforts.     

Threat as a Motivator of Political Activism: A Field Experiment

The research reported here examined the effects of two potential motivators of political activism—policy change threat and policy change opportunity—in a field experiment. Different versions of a letter were sent by a political lobbying organization to potential contributors. One version highlighted threats of undesirable policy changes, another version highlighted opportunities for desirable policy changes, and the third version did neither. Policy change threat increased the number of financial contributions made to the interest group, but policy change opportunity did not. Policy change opportunity increased the number of signed postcards returned to be sent to President Clinton, but policy change threat did not. These findings highlight the impact of interest group recruitment strategies on citizen responsiveness and demonstrate the need to account for sources of motivation in order to more fully understand when, why, and how citizens choose to become politically active.     

中小学师生的校园暴力内隐观研究

本研究用自编问卷对2386名中小学生和504名中小学教师进行了调查,结果表明,中小学师生普遍认可比较严重的身体攻击和性骚扰为校园暴力,不太认可言语攻击为校园暴力。学生的内隐观存在性别、城乡和年级差异,教师的内隐观基本不受性别、城乡、年级和学历影响。教师比学生更认可身体攻击为校园暴力,而学生比教师更认可言语攻击、财产破坏和一般性的体罚为校园暴力。     

Safety Planning Based on Lethality Assessment for Partners of Batterers in Intervention Programs

Summary

This chapter outlines a process of individualized safety planning with the partners of batterers in intervention programs that is based on the principles of empowerment and autonomy, and takes into account the context of the woman's situation. Assessing context is operationalized as considering the potential lethality of the situation from her partner, her relationship and emotional status, available resources, and her children. The safety planning process is described as an opportunity for the abused woman to gain information in order to strategize her responses. It is also a way for the program staff to gain more accurate information about the batterer's level of violence and dan-gerousness, and to work with women to enhance retention of abusers in the program.     

Gruesomeness conveys formidability: Perpetrators of gratuitously grisly acts are conceptualized as larger,stronger, and more likely to win

While associated with extreme terrorist organizations in modern times, extensive accounts of grisly acts of violence exist in the archeological, historical, and ethnographic records. Though reasons for this dramatic form of violence are multifaceted and diverse, one possibility is that violence beyond what is required to win a conflict is a method by which violent actors communicate to others that they are formidable opponents. The formidability representation hypothesis predicts that formidability is cognitively represented using the dimensions of envisioned bodily size and strength. We tested the informational ramifications of gruesome acts using two vignette studies depicting individuals who either did or did not grievously damage the corpse of a deceased foe. Participants rated the individual's height, bodily size, and strength, as well as his aggressiveness, motivation, and the capacity to vanquish opponents in future conflicts. Results indicate that, as predicted, committing gruesome acts of violence enhances perceptions of formidability as measured both by envisioned bodily size and strength and expectations regarding the outcomes of agonistic conflicts. Moreover, the gruesome actor was perceived as more aggressive and more motivated to overcome his enemies, and this mediated the increase in conceptualized size and strength. These results both provide further evidence for the formidability representation hypothesis and support the thesis that overtly grisly violence is tactically employed, in part, because it conveys information about the perpetrator's formidability.     

Identifying the Function of School Refusal Behavior: A Revision of the School Refusal Assessment Scale

A revision of the School Refusal Assessment Scale (SRAS-R), a measure designed to help clinicians identify the primary function of a child's school refusal behavior, was examined. Changes in the original version of the scale were made to improve psychometric quality and align the measure in accordance with evolutions in the functional model. Two samples of youth with school refusal behavior, in addition to parents and teachers, were evaluated to determine the test-retest and interrater reliability and construct and concurrent validity of the SRAS-R. The scale was found to have good psychometric strength. Implications of these findings for clinicians who address this population are discussed.     

Paws for Intervention: Perceptions About the Use of Dogs in Schools

Research in the field of animal-assisted therapy has shown that therapy dogs have a positive social-emotional impact on individuals in hospitals, nursing homes, and counseling. Recently, the literature has suggested that therapy dogs can yield positive psychological, social, and academic outcomes in schools, although this research is quite limited. The intent of this study was to examine perceptions on the effectiveness of therapy dogs in schools for promoting students’ psychological well-being, and an overall positive school climate. Preliminary evidence shows faculty and students from four rural school districts across Western New York indicated support for this emerging and viable school intervention. This qualitative and quantitative insight can help guide future research.     

The Effects of Children's Exposure to Domestic Violence: A Meta-Analysis and Critique

A wide range of children's developmental outcomes are compromised by exposure to domestic violence, including social, emotional, behavioral, cognitive, and general health functioning. However, there are relatively few empirical studies with adequate control of confounding variables and a sound theoretical basis. We identified 41 studies that provided relevant and adequate data for inclusion in a meta-analysis. Forty of these studies indicated that children's exposure to domestic violence was related to emotional and behavioral problems, translating to a small overall effect (Z _r = .28). Age, sex, and type of outcome were not significant moderators, most likely due to considerable heterogeneity within each of these groups. Co-occurrence of child abuse increased the level of emotional and behavioral problems above and beyond exposure alone, based on 4 available studies. Future research needs are identified, including the need for large-scale longitudinal data and theoretically guided approaches that take into account relevant contextual factors.     

A Review of the Stereotype Threat Literature and Its Application in a Neurological Population

Stereotype threat is a situational phenomenon, leading to test performance decrements, in which a member of a stigmatized group feels pressured by the possibility of confirming or being judged by a negative stereotype. This review article highlights the progression of research in the stereotype threat field, and its relevance to neurological populations. Early studies focused on demonstrating this effect in African American, women, and elderly populations. Since this time, research has continued to focus on these populations but has moved to elucidating stereotype threat's mediating psychological factors, studying the impact of individual differences in response to stereotype threat, and attempting to reduce its overall effect. A proposal for further study in neurological populations, under the framework of stereotype threat, comprises the last portion of the paper. It is argued that this social psychological phenomenon may, at least in part, account for poor neuropsychological test performance for neurologically compromised individuals.     

Pediatric Do-Not-Attempt-Resuscitation Orders and Public Schools: A National Assessment of Policies and Laws

Some children living with life-shortening medical conditions may wish to attend school without the threat of having resuscitation attempted in the event of cardiopulmonary arrest on the school premises. Despite recent attention to in-school do-not-attempt-resuscitation (DNAR) orders, no assessment of state laws or school policies has yet been made. We therefore sought to survey a national sample of prominent school districts and situate their policies in the context of relevant state laws. Most (80%) school districts sampled did not have policies, regulations, or protocols for dealing with student DNARs. A similar majority (76%) either would not honor student DNARs or were uncertain about whether they could. Frequent contradictions between school policies and state laws also exist. Consequently, children living with life-shortening conditions who have DNARs may not have these orders honored if cardiopulmonary arrest were to occur on school premises. Coordinated efforts are needed to harmonize school district, state, and federal approaches in order to support children and families' right to have important medical decisions honored.     

Fear of Death in Hypochondriasis: Bodily Threat and Its Treatment Implications

This article aims to explore the perception of body in hypochondriasis and implications that it has for fear of death and for treatment of hypochondriasis. It is suggested that a sense of threat posed by the body in hypochondriasis is intimately related to the fear of body, expectations of bodily failure, fear of disease and pathological fear of death. Clinical aspects and potential antecedents of these phenomena are discussed in the article. It is emphasized that fear of the body and fear of death should be adequately addressed in the course of treatment, regardless of the nature of the primary treatment approach. Relevant treatment strategies are outlined, with treatment goals including an adoption of the non-threatening perception of one’s body, modification of attitudes and beliefs related to health, illness and death which heighten fear of death, and substantial alleviation or elimination of the pathological fear of death.     

Private psychotherapy training in Italy: A systematic analysis

This paper examines the results of a systematic analysis, organised by the Italian Ministry of Education, University and Research, of private psychotherapy training in Italy. Since 1989, training in psychotherapy in Italy has been governed by a national law which recognises both public and private institutions. While the public system usually comprises approximately 150 students, the private system has grown significantly over time, registering thousands of students in hundreds of schools (for example, 19,123 students in 212 schools in 2011). Systematic analysis variables included geographical distribution, theoretical approaches, training methods, student and teacher characteristics, student’s personal psychotherapy, supervision and apprenticeships. Data were obtained from 92% of the schools. The primary issues discussed in this paper are as follows: the uneven geographical distribution of the schools; the disorderly amalgamation of traditional scientific paradigms; programmes which concentrate on theory and fail to meet international guidelines. One key issue is the excess supply with regard to demand, meaning that recently graduated psychotherapists (especially women) risk underemployment and financial hardship. Student enrolment is also increasingly problematic. This is the first paper to present an in-depth analysis of one European country’s situation in this field. The authors believe it will foster comparison and discussion internationally.