Category: Emotional Wellbeing

Treatment of Suicidal and Self-Injurious Adolescents with Emotional Dysregulation

Written by matthew on . Posted in Emotional Wellbeing. 1 Comment

Study Title: Treatment of Suicidal and Self-Injurious Adolescents with Emotional Dysregulation

Study Aims: The long term aim of our research is to develop and evaluate effective treatments for adolescents at high risk for suicide that will reduce suicidal and self-injurious behaviors as well as improve functioning and the quality of life of teens and their families. The primary aim of the research proposed here is to evaluate the efficacy of dialectical behavior therapy (DBT) for adolescents by comparing it to a combined individual and group supportive therapy control condition (I/GST) chosen specifically to maximize internal validity.

Methods: Subjects will be 170 teens 13-17 years old with borderline personality traits referred to treatment due to high risk for suicide. Outcome targets include reduced frequency and severity of suicidal behaviors, especially suicide attempts, inpatient or ER treatment for suicidality, increased maintenance in and compliance with treatment, and enhanced functioning across multiple domains. DBT has an empirical track record with adults of reducing the incidence, frequency and medical risk of suicide attempts and non-suicidal self-injuries among individuals meeting criteria for borderline personality disorder (BPD). However, although DBT is widely used with suicidal adolescents, particularly those with difficulties characteristic of BPD such as poor emotion regulation and impulse control, no randomized trial of DBT with adolescents has been conducted. Thus, although non- randomized trials suggest effectiveness, without a randomized trial we simply do not know whether DBT for adolescents is efficacious or not. Given the severity of the problem and the lack of alternative treatments for high risk adolescents, addressing this question is important. The second aim of this research is to analyze mediators of reduced suicidal and self-injurious behaviors in adolescents. DBT is based on a theoretical model that suicidal behavior is a combined outcome of high stressful events and emotion dysregulation together with inadequate behavioral skills for coping with negative emotions and life events. Risk factors for adolescent suicide and intentional self-injury include most importantly family conflict but also conflict with peers, teachers, losses, legal or disciplinary problems (stressful events) combined with high negative emotions and inadequate abilities in emotion regulation. We will analyze the potential mediating effects on suicidal behaviors of decreases in family conflict, increases in parent DBT behavioral skills, reductions in emotion dysregulation and increases in DBT behavioral skills. Preliminary data on cost-effectiveness will also be collected.

Investigators: Michele Stacy Berk, Judith Cohen

Trauma-Focused Cognitive Behavioral Therapy for Adjudicated Youth in Residential Treatment

Written by matthew on . Posted in Emotional Wellbeing. Leave a Comment

Study Title: Trauma-Focused Cognitive Behavioral Therapy for Adjudicated Youth in Residential Treatment

Context: Adjudicated youth have high rates of trauma exposure and   Stress Disorder (PTSD) which place them at increased risk for future offending and incarceration. Few of these youth receive evidence-based developmentally appropriate PTSD treatment.

Study Aims: Adjudicated youth have high rates of trauma exposure and Posttraumatic Stress Disorder (PTSD) but most have never received effective treatment. The purpose of this study is to test two alternative methods for training therapists to deliver an evidence- based trauma treatment to adjudicated youth with PTSD symptoms during residential treatment and therefore decrease their risk of future offending and incarceration

Methods: This study proposes to evaluate two alternative strategies for training therapists to deliver a proven youth trauma treatment, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) to adjudicated youth in ten juvenile justice RTF programs in New England. All RTF programs will receive organizational readiness consisting of 1) novel integrated trauma training for RTF staff (direct care milieu staff, teachers and administrators) about trauma impact and how to support TF-CBT implementation in the RTF; and 2) PTSD assessment training for therapists. Randomization will then occur within each RTF program at the therapist level, to one of two TF-CBT delivery strategies: 1) Web-based TF-CBT Delivery (“W”) in which therapists will receive web-based training and web-based consultation via the TF-CBTWeb and TF-CBTConsult distance learning programs; or 2) W+ Live (“W+L”) in which therapists will receive W+ face-to-face 2-day expert TF-CBT training and ongoing twice monthly expert phone consultation and training to TF-CBT fidelity standards via audiotape rating. The study’s central hypothesis is that W+L will lead to superior outcomes. However, based on cost- effectiveness analyses, W may be acceptable. The study will evaluate the differences in outcomes between the two strategies in terms of the following hypotheses: 1) fidelity: W+L strategy will lead to greater treatment fidelity and to youth receiving greater RTF staff support in TF-CBT delivery than W; several mechanisms are proposed for these differences; 2) improved youth outcomes: W+L will lead to greater improvement in youth PTSD and depressive symptoms than W; and 3) broad and sustained TF-CBT uptake: more youth will receive TF-CBT from W+L than from W therapists; 4) cost effectiveness: W may be acceptable due to cost effectiveness analyses.

Principal Investigator: Judith Cohen (Allegheny General Hospital)

Pathways to health and well-being: social networks of orphans and abandoned youth

Written by matthew on . Posted in Emotional Wellbeing. Leave a Comment

Study Title: Pathways to health and well-being: social networks of orphans and abandoned youth 

Context: Globally, 153 million children are estimated to have been orphaned as defined by the death of one or both parents due to diseases such as malaria, tuberculosis, maternal mortality, unintentional injuries, natural disasters and armed conflict: AIDS accounts for 16.6 million of these children. Little is known, however, about the social networks that have been informally established that may assist orphaned and abandoned children (OAC) as they transition from structured family care or residential facility settings to their adult lives.

Study aims: The primary goal of this study is to determine key factors that may put youth at a disadvantage as they transition from structured care settings into their adult lives and those that support positive transitions. To accomplish this, researchers will study existing education and employment support networks as well as sexual communities. Researchers will then be able to determine how certain characteristics of these networks are associated with OAC health outcomes, including poor education, ability to generate income, and HIV risk-taking behaviors. Based on prior OAC-related research, this study expects to find that OAC networks are small and lack variability, leading to reduced access to education, fewer positive employment opportunities, and increased sexual-risk behavior. Findings will be used to construct potential interventions to promote OAC health and well-being.

Methods: This study will use a “network analysis approach” to identify major characteristics of OAC social and sexual networks. Researchers will then examine the association between network factors and OAC outcomes in two steps: examining the relationships between social network characteristics and education and income-generation outcomes, and between sexual network characteristics and HIV-risk outcomes. Researchers expect to learn which social and sexual network features are associated with poor outcomes, such as educational accomplishment, obtaining employment, and high sexual risk behavior. Such risk behaviors include an early age of sexual debut, a high number of sexual partners, and certain characteristics of the sexual partners themselves. This research will provide the basis for designing interventions to prevent disenfranchisement as OAC enter their adult lives. With this research, we will be able to learn how to effectively design community networks for OAC to prevent poor health and lifestyle outcomes.

Policy Implications:

  • To determine if OAC network features account for success in educational, income generation, and sexual risk-taking behaviors
  • To provide the basis for social network and sexual network interventions to reduce damage done to OAC to prevent disenfranchisement as OAC become adults.

Principal Investigator: Lynne Messer (Duke University)

Investigators: Bernard Agala (Duke University), Cyrilla Amanya (ACE Africa, Kenya), Misganaw Eticha (SVO Ethiopia), Amy Hobbie (Duke University) Dafrosa Itemba (TAWREF, Tanzania), Rachel Manongi (KCMC, Tanzania), Jim Moody (Duke University), Vanroth Vann (Homeland, Cambodia), Augustine Wasonga (ACE Africa, Kenya), Kathryn Whetten (Duke University), Rachel Whetten (Duke University)

Contact: duke.ovcstudies@gmail.com

Randomized Controlled Trial of Ways to Improve OVC HIV Prevention and Well-Being (Zambia CBT)

Written by matthew on . Posted in Emotional Wellbeing. 1 Comment

Study Title: Randomized Controlled Trial of Ways to Improve OVC HIV Prevention and Well-Being (Zambia CBT)

Context: With millions of youth orphaned by AIDS in sub-Saharan Africa undergoing high levels of stress-related problems—such as interpersonal and problem-solving skills deficits, unhealthy thoughts, and maladaptive behaviors—addressing trauma and stress is a pressing need. Addressing these stressors is especially important in preventing the spread of HIV by reducing stress-induced risky sexual behaviors among orphaned and vulnerable children. Other studies have shown that cognitive behavior therapy interventions, when adapted for local environments, have been effective in addressing such stress-related problems.

Study Aims: This study will focus on comparing the effectiveness of psychosocial counseling (PC) and trauma-focused cognitive behavioral therapy (TF-CBT). The study will primarily compare the effectiveness of psychosocial counseling and trauma-focused cognitive behavioral therapy in addressing the stress-related problems among orphaned and vulnerable children (OVC). In addition, the study will examine the effectiveness of these two major types of treatment in reducing sexual risk behaviors while accounting for factors that mediate and moderate HIV risk behaviors. Finally, this study will compare the cost-effectiveness of the two treatment methods.

Methods: This study, which is being conducted in Zambia, utilizes a randomized controlled trial of psychosocial counseling and trauma-focused cognitive behavioral therapy, which has been utilized in other previous and ongoing studies. The major outcomes that this study will analyze include HIV risk behaviors, emotional and behavioral health, social support, overall well-being and mental health development of OVC. Researchers will recruit adolescents aged 13-17 who report risky sexual behavior, including recent sex without a condom. Adolescent participants and their caregivers will be assessed utilizing a computerized interviewing program that will enhance privacy and honesty of responses.

Policy Implications:

  • This study will provide necessary scientific evidence on the feasibility, effectiveness, and cost effectiveness of interventions for OVC affected by HIV/AIDS.
  • Results from this study will help inform efficient program design, policy, and effectiveness of interventions for preventing HIV among OVC living in low-resource settings.

M-Principal Investigators: Laura Murray (Johns Hopkins University) and Paul Bolton (Harvard University)

Investigators: Judith Cohen (University of Pittsburg), Shannon Dorsey (University of Washington), Kathryn Whetten (Duke University),

Contact Information: duke.ovcstudies@gmail.com

 

Improving Outcomes for Orphaned Youth: Implementation of Trauma-Focused Cognitive Behavioral Therapy for Childhood Traumatic Grief

Written by matthew on . Posted in Emotional Wellbeing. 1 Comment

Study Title: Improving Outcomes for Orphaned Youth: Implementation of Trauma-Focused Cognitive Behavioral Therapy for Childhood Traumatic Grief

Context: Approximately 50 million orphaned and abandoned adolescents currently live in sub-Saharan Africa. Previous studies have indicated that many of these children and adolescents, who often have mental health problems associated with parental loss, have high rates of other traumatic experiences and ongoing trauma exposure. Because the gap in mental health care is large in sub-Saharan Africa, with few individuals in need of treatment receiving even minimal support, more information regarding how to best implement effective interventions, like Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for orphaned and abandoned children (OAC) is needed. Cognitive behavioral therapy approaches have been shown to be effective in low- and middle-income countries with adults and in wealthier nations with children and adolescents. More research on the effectiveness of CBT approaches effect resource-poor settings is needed. It is also critical to identify what level of provider and supervisor support is needed for maximum effectiveness and local feasibility. 

Study Aims: This research will examine the effectiveness of TF-CBT for treating unresolved grief and traumatic stress for OAC and adolescents in two East African countries, Tanzania and Kenya. The randomized trial will examine the effectiveness of TF-CBT compared to receipt of services as usual in these countries. The study involves collaboration with local organizations in Tanzania and Kenya, in which nine local counselors in each country will be trained by both a US-based TF-CBT expert and Tanzanian lay counselors who gained TF-CBT expertise in a previous feasibility study of TF-CBT for OAC, to deliver group-based TF-CBT for childhood traumatic grief to children ages 7-13. This study will evaluate the effectiveness of TF-CBT compared to existing services as usual orphan supports. The study will also examine the impact of implementation factors (e.g., intervention fidelity, lay counselor-supervisor relationship, child/guardian attendance) to study how enhanced local involvement and responsibility (i.e., Tanzanian lay counselor involvement in co-training and supervision) impacts outcomes.

Methods: This study build on previous work demonstrating that TF-CBT is a feasible and acceptable approach for OAC and adolescents by including a control group to properly examine the effectiveness of the TF-CBT approach. The 18 counselors who are trained in TF-CBT will deliver the treatment in 20 groups in each country, 10 rural and 10 urban, resulting in a total of 320 children and adolescents receiving the treatment (40 groups). TF-CBT and mental health experts will oversee the training of the lay counselors and the treatment given to the groups.

Policy Implications:

  • The study will examine the effectiveness of TF-CBT treatment for OAC and adolescents, as compared to receipt of services as usual in two East African Countries.
  • Incorporating experienced lay counselors in providing training and supervision in TF-CBT will inform future efforts to build local expertise and sustainability. This work will inform not only TF-CBT for CTG efforts but also efforts for scale up of other mental health interventions.
  • Generate important recommendations for OAC treatment and training approaches that are effective in low- and middle-resource settings.

M-Principal Investigators: Shannon Dorsey (University of Washington) and Kathryn Whetten (Duke University)

Investigators: Dafrosa Itemba (TAWREF), Kevin King (University of Washington), Rachel Manongi (KCMC), Karen O’Donnell (Duke University), Augustine Wasonga (ACE Africa)

Contact Information: duke.ovcstudies@gmail.com

  • 1
  • 2

FOLLOW US FOR OVC UPDATES: