Elaine Walsh

Healing fractured families: parents' and elders' perspectives on the impact of colonization and youth suicide prevention in a Pacific Northwest American Indian tribe

Suicide rates among American Indian youth in the United States are two to three times the national average. Risk factors for American Indian youth include depression, alcohol use, hopelessness and stress, and family conflict, abuse, poverty, and instability. In this descriptive study, the authors aimed to obtain parents’ and elders’ perspectives on community needs and to identify strengths on which the community might build to reduce youth suicide risk. Data were collected from focus groups with 40 American Indian parents and from individual interviews with 9 American Indian elders. The major task participants addressed was holding the family together and healing intergenerational pains. Topics parents discussed were holding onto cultural values, holding the family together, getting through school, and getting a job. These findings substantiate previous research and provide useful information for the design of culturally appropriate family or community-based interventions to prevent American Indian youth suicide.

Perspectives on provider behaviors: A qualitative study of sexual and gender minorities regarding quality of care

Abstract Lesbian, gay, bisexual, transgender, and queer (LGBTQ) identified patients report receiving substandard care from healthcare providers. They face the fear and disturbing reality of discrimination when accessing health care. Without culturally sensitive treatment, nursing and other health professions do not properly care for this population. Following the recent trend towards awareness and need for inclusion of LGBTQ populations in healthcare, this paper provides a summary of the current literature on the treatment and needs of LGBTQ people and describes focus groups conducted to explore perceptions regarding provider behaviors. It concludes with a list of behaviors that enhance or impede quality care that can serve as a guide for healthcare professionals.

Multi-domain risk and protective factor predictors of violent behavior among at-risk youth

This study extends prior examination of adolescent violence etiology, drawing on an ethnically diverse, community accessed, yet emotionally vulnerable sample (N=849) of adolescents at-risk for school dropout. A balanced risk and protective factor framework captured theorized dimensions of strain, coping, and support resources. We tested the combined and unique contribution of risk and protective components spanning individual, peer/school, and family predictor domains, including victimization histories. Hierarchical regressions yielded significant overall explanation of violent behaviors as well as unique predictors within each of the three domains. Tests for sex differences and moderating effects suggested that levels of risk and protective factors differed for males and females, although the functional relationships to violence were the same for both sexes. Results are discussed relative to prevention and early intervention programs; particularly the importance of understanding adolescent violent behaviors within a context that addresses stress and distress.

Promoting CARE: including parents in youth suicide prevention.

This study evaluated the effectiveness of augmenting a youth suicide-preventive intervention with a brief, home-based parent program. A total of 615 high school youth and their parents participated. Three suicide prevention protocols, a youth intervention, a parent intervention, and a combination of youth and parent intervention, were compared with an “intervention as usual” (IAU) group. All groups experienced a decline in risk factors and an increase in protective factors during the intervention period, and sustained these improvements over 15 months. Results reveal that the youth intervention and combined youth and parent intervention produced significantly greater reductions in suicide risk factors and increases in protective factors than IAU comparison group.

School-Wide Staff and Faculty Training in Suicide Risk Awareness: Successes and Challenges

PROBLEM Rates of youth suicide and suicidal behavior remain high despite prevention efforts. Training high school personnel as gatekeepers is an important strategy. METHODS Training was implemented in a school districts five comprehensive high schools. Surveys were conducted before and after training sessions, which targeted all adults working at the high school. Two hundred thirty-seven individuals completed the pretest and/or posttest. FINDINGS Participants reported gains in knowledge, confidence, and feelings of competence in recognizing, approaching, and connecting distressed youth to school-based resources. Training was well received. CONCLUSION Training is acceptable and appropriate for school personnel. Increasing the number of school personnel who participate in the training is challenging.

Violent Victimization and Perpetration: Joint and Distinctive Implications for Adolescent Development

Abstract To date few reports have provided direct comparison of psychosocial vulnerability and resources among youth with victimization and perpetration histories. Within a racially diverse, high-risk adolescent sample (n = 849), this study undertakes MANCOVA tests on a multidimensional set of risk and protective factors contrasting youth with histories of (1) neither violent victimization nor perpetration, (2) victimization only, (3) perpetration only, and (4) both victimization and perpetration. All three violence-affected groups reported elevated risk and diminished protection, with perpetrating victims demonstrating the greatest psychosocial impairment. Detailed contrasts among the youth group profiles provide insights regarding overlapping and distinct developmental etiologies and implications for preventive and remedial intervention.

Preventing youth suicide: issues for law enforcement personnel.

Suicide is a leading cause of death for adolescents. A number of problem behaviors associated with youth suicide fall into the purview of law enforcement personnel, and they are therefore in a position to detect risk and prevent suicidal behaviors. Eight hundred one youth identified as having school difficulty, a group at increased risk for both suicide and legal problems, participated in a paper and pencil survey followed by an interview focusing on suicide risk and protective factors. Linear regression was used to examine the ability of factors within each risk and protective factor dimension to predict current suicide risk. The study goal was to determine the most relevant factors influencing suicide risk in each domain examined. Findings are discussed in terms of implications for assessment and policy for law enforcement personnel.

Vulnerability, Stress, and Support in the Disease Trajectory from Prodrome to Diagnosed Schizophrenia: Diathesis–Stress–Support Model

Schizophrenia is a debilitating psychiatric disorder seen across the world. The goal of current research is to provide a more comprehensive understanding of prodrome, the initial period before the disease manifests as schizophrenia. Unfortunately, there is little information to comprehensively understand the indicators that later lead to schizophrenia. This has resulted in a lack of scientific knowledge to aid in early identification and intervention by psychiatric nurses or school nurses. Such information could inform nursing assessment and care plan development. The purpose of this paper is to construct a conceptual model for describing the important factors relating to the schizophrenia prodrome process in human developmental manner by critically synthesizing empirical evidence and reviewing the strengths and limitations of current conceptual models.

Trajectories of parent-adolescent relationship quality among at-risk youth: parental depression and adolescent developmental outcomes.

BACKGROUND Although the parent-adolescent relationship has been studied intensely, predictors and consequences of changes in the quality of the relationship across time have not been examined. OBJECTIVES This study examined the role of parent depression on changes in the parent-adolescent relationship, defined as support and conflict, and subsequent effects of relationship change on adolescent psychosocial outcomes including risky behavior, substance use, depressive symptoms, and hopelessness. METHOD Using data from a large prevention study, the sample included 110 youth at risk for high school drop out from the control condition; the sample was 48.2% of female, with a mean age of 15.9years. The data, gathered from adolescents and their parents across a period of approximately 18months, were analyzed using growth mixture modeling. RESULTS Three distinct trajectories for parent-adolescent conflict (high-decreasing, low-increasing, low-stable trajectory) were identified as well as a single growth model for support, which revealed a slight decline in support across time. Parent depression was a significant predictor of perceived support, but not of membership in trajectories of conflict. Low parent-adolescent support was associated with adolescent depression and hopelessness measured 18months post-baseline. Adolescents in the low but increasing conflict trajectory and those having a parent with depression reported increased depression and hopelessness 18months later. DISCUSSION Parent-Adolescent support and conflict were associated with adolescent emotional outcomes, particularly depression and hopelessness. The findings provide evidence that will inform prevention strategies to facilitate parent-adolescent support, minimize the negative impact of relationship conflict, and thereby promote healthy psychosocial outcomes for at-risk adolescence.

Adverse Childhood Experiences

Clear and compelling evidence suggests that not only do adverse childhood experiences have immediate impacts on child development and well-being, but they also have longterm consequences for adult health and healthcare utilization (Bethell, Newacheck, Hawes, & Halfon, 2014; Chartier, Walker, & Naimark, 2010; Smith & Smith, 2010). Adverse childhood experiences include extreme economic hardship; parental separation or divorce; living with someone with a substance abuse problem or mental illness; witnessing neighborhood or domestic violence; physical, sexual, or emotional abuse or neglect; parental incarceration; parental death; and unfair treatment due to race/ethnicity (Bethell et al., 2014). These experiences are common: 48% of children ages 0–17 years in the United States experience at least one adverse childhood experience and 23% experience two or more (Bethell et al., 2014). The greatest opportunities for mitigating the impacts of these experiences and preventing long-term adult health consequences and healthcare utilization occur during childhood and adolescence. A multilevel approach by scientists, healthcare providers, and schools is needed to prevent adverse childhood experiences whenever possible, identify children and adolescents early when these events occur, and provide resources and programs to assist these children and their families. Schools have a unique opportunity to identify children and families at risk, to intervene, and to link families to family-centered medical homes and other community resources. Children with adverse health experiences are less likely to have positive health factors such as demonstrating resilience, living in a protective home environment, or a safe and supportive neighborhood. With each additional adverse experience, children are less likely to have positive health factors. Children with two or more adverse childhood experiences are especially vulnerable; they are less likely to demonstrate resilience, live in a protective home environment, or a safe and supportive neighborhood (Bethell et al., 2014). These children will need significant support to mitigate the impacts of adverse experiences and prevent long-term consequences for their health and healthcare utilization. Schools play a critical role in identifying children who are experiencing an adverse event early. School personnel (e.g., school nurses, teachers, counselors) are the most likely to be aware of adverse events through communication with parents or children. If these events are not communicated, teachers are most likely to see subtle changes in behavior that may indicate need for additional screening or referral by a school nurse or counselor. Once children who experience adverse events are identified, we must offer services and resources. Rather than “wait and see” how they do, and intervene only if they show signs of maladjustment, we need to be proactive and assist these children develop coping strategies and build resiliency when adversities occur. Children who have experienced adverse childhood events are less likely to be engaged in school and more likely to repeat a grade in school (Bethell et al., 2014). Teachers are the first line for noticing subtle changes in school engagement, which would indicate further screening. In addition, school counselors and nurses may detect possible issues during routine check-ins or related to referrals. Children who repeat a grade or engage in problematic behavior in school should be screened for adverse childhood events so they are not missed, resulting in ongoing issues. In addition to identifying children at risk, schools can link children and families to resources in the community. School personnel are ideally situated to facilitate connections with resources to counteract the effects of adverse experiences. They can encourage children and families to take advantage of existing resources, and they can assist families to locate resources. In addition to having trusting relationships with children and families, school personnel serve as advocates for families to identify and utilize resources. Children who experience two or more adverse events were less likely to receive health care from a family-centered medical home (Bethell et al., 2014). These medical homes get to know the child and the child’s health history and can coordinate care and services outside of primary care. Schools should be aware of family-centered medical homes that serve their community and can connect families with them when possible. With proper consent and in appropriate circumstances, communication with medical homes can also enhance continuity of care between school, medical, and home settings. As children and adolescents experience life stress, school can be a place of refuge or a place where they learn resiliency skills. A first step in this involves understanding when children are distressed, anticipating needs based on experiencing adverse events, and working collaboratively with children and families to link them with appropriate support. Recognition and early doi: 10.1111/jcap.12105 bs_bs_banner