Omar G. Gudiño

Understanding Racial/Ethnic Disparities in Youth Mental Health Services Do Disparities Vary by Problem Type?

The authors examined racial/ethnic disparities in mental health service use based on problem type (internalizing/externalizing). A diverse sample of youth in contact with public sectors of care and their families provided reports of youths symptoms and functional impairment during an initial interview. Specialty and school-based mental health service use during the subsequent 2 years was assessed prospectively. Greater disparities in mental health service receipt were evident for internalizing problems, with non-Hispanic White youth more likely to receive services in response to internalizing symptoms than minority youth. Fewer disparities in rates of unmet need emerged for externalizing problems, but minority youth were more likely to have need for externalizing problems met and African American youth were particularly likely to receive services in response to such problems. Findings highlight the importance of considering problem type when examining racial disparities in mental health services and underscore concerns about the responsiveness of mental health services for minority youth with internalizing disorders.

Parent Training With High-Risk Immigrant Chinese Families: A Pilot Group Randomized Trial Yielding Practice-Based Evidence

We studied the efficacy and implementation outcomes of a culturally responsive parent training (PT) program. Fifty-four Chinese American parents participated in a wait-list controlled group randomized trial (32 immediate treatment, 22 delayed treatment) of a 14-week intervention designed to address the needs of high-risk immigrant families. Parents were eligible for intervention if they were Chinese-speaking immigrants referred from schools, community clinics, or child protective services with concerns about parenting or child behavior problems. Retention and engagement were high with 83% of families attending 10 or more sessions. Results revealed that the treatment was efficacious in reducing negative discipline, increasing positive parenting, and decreasing child externalizing and internalizing problems. Treatment effects were larger among families with higher levels of baseline behavior problems and lower levels of parenting stress. Further augmentation of PT to address immigrant parent stress may be warranted. Qualitative impressions from group leaders suggested that slower pacing and increased rehearsal of skills may improve efficacy for immigrant parents unfamiliar with skills introduced in PT.

Maternal Posttraumatic Stress Disorder and Depression in Pediatric Primary Care: Association With Child Maltreatment and Frequency of Child Exposure to Traumatic Events

IMPORTANCE Maternal posttraumatic stress disorder (PTSD) may be associated with increased risk for child maltreatment and child exposure to traumatic events. Exposure to multiple traumatic events is associated with a wide range of adverse health and social outcomes in children. OBJECTIVE To examine the association of probable maternal depression, PTSD, and comorbid PTSD and depression with the risk for child maltreatment and parenting stress and with the number of traumatic events to which preschool children are exposed. DESIGN Cross-sectional observational design. We used analysis of variance to determine whether probable maternal psychopathology groups differed on child maltreatment, parenting stress, and childrens exposure to traumatic events. Hierarchical regression analyses were used to examine the unique and interactive effects of depression and PTSD severity scores on these outcomes. SETTING Urban pediatric primary care outpatient clinic. PARTICIPANTS Ninety-seven mothers of children aged 3 to 5 years. EXPOSURE Pediatric primary care visit. MAIN OUTCOMES AND MEASURES Probable maternal depression and/or PTSD, parenting stress, child exposure to traumatic events, and child maltreatment. RESULTS Mothers with probable comorbid PTSD and depression reported greater child-directed psychological aggression and physical assault and greater parenting stress. The children of mothers with PTSD (mean number of events the child was exposed to, 5.0) or with comorbid PTSD and depression (3.5 events) experienced more traumatic events than those of mothers with depression (1.2 events) or neither disorder (1.4 events). Severity of depressive symptoms uniquely predicted physical assault and neglect. Symptom scores for PTSD and depression interacted to predict psychological aggression and child exposure to traumatic events. When PTSD symptom severity scores were high, psychological aggression and the number of traumatic events children experienced rose. Depressive symptom severity scores predicted the risk for psychological aggression and exposure to traumatic events only when PTSD symptom severity scores were low. CONCLUSIONS AND RELEVANCE Children of mothers with PTSD are exposed to more traumatic events. Posttraumatic stress disorder is associated with an increased risk for child maltreatment beyond that associated with depression. Screening and intervention for maternal PTSD, in addition to maternal depression, may increase our ability to reduce childrens exposure to traumatic stress and maltreatment.

Problem-specific racial/ethnic disparities in pathways from maltreatment exposure to specialty mental health service use for youth in child welfare

The authors examined racial/ethnic differences in pathways from maltreatment exposure to specialty mental health service use for youth in contact with the Child Welfare system. Participants included 1,600 non-Hispanic White, African American, and Latino youth (age 4–14) who were the subjects of investigations for alleged maltreatment and participated in the National Survey of Child and Adolescent Well-Being. Maltreatment exposure, internalizing, and externalizing problems were assessed at baseline and subsequent specialty mental health service use was assessed 1 year later. Maltreatment exposure predicted both internalizing and externalizing problems across all racial/ethnic groups, but non-Hispanic White youth were the only group for whom maltreatment exposure was linked with subsequent service use via both internalizing and externalizing problem severity. Only externalizing problems predicted subsequent service use for African American youth and this association was significantly stronger relative to non-Hispanic White youth. Neither problem type predicted service use for Latinos. Future research is needed to understand how individual-, family-, and system-level factors contribute to racial/ethnic differences in pathways linking maltreatment exposure to services via internalizing/externalizing problems.

Psychology of Asian American Children: Contributions of Cultural Heritage and the Minority Experience

This chapter presents information on mental health issues in Asian American children, focusing on cultural orientation and minority-related experiences as posing challenges to the maintenance of mental health, as well as providing strengths which contribute to resilience in this group. We then recommend some ways through which we may draw upon the strengths of Asian American youth to promote resiliency and overcome vulnerabilities in adjustment.

Immigration and mental health

The mental health of immigrants is influenced by the experiences of individuals interacting with their social contexts. Given that immigrants to the United States represent a heterogeneous group in terms of origins and experiences, understanding their mental health requires an examination of the circumstances surrounding migration and in receiving communities. While immigrants may confront a host of challenges, one relatively robust finding suggests lower prevalence of psychiatric disorders among immigrants compared to their US-born counterparts. This article reviews factors contributing to immigrant mental health and evaluates explanations for findings suggesting better mental health in immigrants relative to their native-born peers.

Child Trauma Exposure and Posttraumatic Stress Disorder: Identification in Community Mental Health Clinics

ABSTRACT We examined the identification of trauma exposure and posttraumatic stress disorder (PTSD) in help-seeking urban children (N = 157) presenting for care in community mental health clinics. Children and their parents completed a standard intake assessment conducted by a community clinician followed by a structured, trauma-focused assessment conducted by a study clinician. Clinicians provided ratings of child functional impairment, parents reported on internalizing/externalizing problems, and children provided self-reports of PTSD symptom severity. Although community clinicians were mandated by clinic policy to ask about exposure to physical abuse, sexual abuse, and witnessed domestic violence, they identified exposure to these at significantly lower rates than study clinicians. Rates of PTSD based on community clinician diagnosis (1.9%) were also much lower than rates obtained by study clinicians (19.1%). A review of clinical charts 1 year after intake revealed no change in PTSD diagnosis rate following additional clinical contacts. Clinician-rated impairment, parent-rated emotional/behavioral problems, and child-rated PTSD symptom severity measures provided support for the validity of trauma exposure and PTSD as identified by study clinicians. Trauma exposure and PTSD diagnosis among help-seeking urban youth appear to be underidentified by community clinicians, which may compromise clinicians’ ability to respond to environmental risks and provide appropriate evidence-based treatments.

Predicting Avoidance Symptoms in U.S. Latino Youth Exposed to Community Violence: The Role of Cultural Values and Behavioral Inhibition: Cultural Values and Behavioral Inhibition

Not all youth exposed to violence are at equal risk for developing posttraumatic stress disorder (PTSD), reflecting potential variability in risk factors influencing the development of PTSD beyond exposure to violence. In particular, Latino youth have been found to be at a higher risk for developing PTSD after exposure to violence. Similarly, youth with high levels of behavioral inhibition appear to be at greater risk of developing PTSD following exposure to violence. In this study, we examined how Latino cultural values might be associated with behavioral inhibition and how these two factors together may interact to predict risk for developing PTSD avoidance symptoms, specifically. Data from a longitudinal sample of 168 Latino adolescents (11-15 years of age) indicated that Latino values were positively associated with behavioral inhibition, r = .26, p < .001, and that Latino values moderated the association between behavioral inhibition and avoidance symptoms, β = .16, p = .009, such that the association was stronger as Latino cultural values increased. Results from this study highlight the importance of considering cultural, individual, and contextual factors for understanding risk for PTSD. Future research should further assess the biological and cultural correlates of behavioral inhibition in order to improve understanding of risk and increase effectiveness of individualized intervention approaches.

STAIR Narrative Therapy for Adolescents

Skills Training in Affective and Interpersonal Regulation (STAIR) plus Narrative Therapy – Adolescent Version (SNT-A; Cloitre et al. Skills training in affective and interpersonal regulation for adolescents – revised version (Unpublished manual). National Center for PTSD, Palo Alto) is an evidence-based psychosocial intervention for adolescents with trauma-related difficulties. As its name suggests, STAIR emphasizes the development of emotional and interpersonal skills that can support present functioning and enhance future resilience. In some settings, due to limited amounts of time available (e.g., inpatient stays), only the skills training component of the treatment (STAIR-A) is implemented. However, in other settings, such as in outpatient services or school-based programs, the treatment is extended to include review of traumatic events and the creation of a narrative about the trauma in the context of a developing life story (SNT-A). This chapter provides an overview of the rationale for SNT-A as well as a session-by-session overview accompanied by an illustrative case example to highlight how this approach is applied in real-world practice. We subsequently review typical challenges that can arise when implementing the treatment and discuss how to address them. Finally, we provide a brief summary of the evidence base supporting the use of SNT-A.

Violence Exposure and Psychopathology in Latino Youth: The Moderating Role of Active and Avoidant Coping

Despite high rates of exposure to community violence among Latino youth in urban communities, there is considerable variability in individual outcomes. This study examined (a) associations between coping and indices of Latino culture, (b) main effects of active/avoidant coping on psychopathology, and (c) whether coping moderates the impact of violence exposure on mental health in Latino youth. Participants included 168 Latino youth (56% female; ages 11–14) that took part in a short-term longitudinal study. Results indicate that youth acculturation was positively associated with active coping, but enculturation level and immigrant status were not associated with coping. Structural equation models suggested that active coping was negatively associated with internalizing problems (p = .046) while avoidant coping was positively associated with internalizing problems (p = .013) and posttraumatic stress symptoms (p = .024). Moderation analyses revealed that violence exposure was more strongly associated with internalizing problems as reliance on avoidance coping increased. However, at high levels of violence exposure, a greater reliance on active coping was related to increased posttraumatic stress problems. Findings suggest that consideration of the specific stressor, level of stress exposure, and mental health problem-type may be crucial in determining the effectiveness of a coping strategy. Implications for future research and intervention are discussed.