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This school program evaluation aims to highlight the mental health needs of students in special education with behavioral and emotional challenges and describe the implementation of a resilience curriculum with this population. We evaluated district mental health data from a convenience sample of 814 students in grades 5–12 special education to identify risk for mental health symptoms, violence exposure, and substance use. School social workers provided feedback on the implementation of the resilience curriculum to inform program evaluation. Students reported significant risk for traumatic stress, anxiety, and depressive symptoms, and high rates of violence exposure and substance use. School social workers described adaptations to the resilience curriculum and gave recommendations for future implementation. Students receiving special education services for behavioral and emotional challenges had high mental health need, including high rates of violence exposure, and may benefit from a trauma-informed school-based resilience curriculum adapted for their needs. [ABSTRACT FROM AUTHOR]

How are children's lives altered when a parent goes off to war? What aspects of combat deployment are most likely to put children at risk for psychological and other problems, and what resources for resilience can they tap to overcome such hardships and thrive? To answer these questions, Patricia Lester and Lieutenant Colonel Eric Flake first examine the deployment cycle, a multistage process that begins with a period of anxious preparation after a family receives notice that a parent will be sent into combat. Perhaps surprisingly, for many families, they write, the most stressful part of the deployment cycle is not the long months of separation that follow but the post-deployment period, when service members, having come home from war, must be reintegrated into families whose internal rhythms have changed and where children have taken on new roles. Lester and Flake then walk us through a range of theoretical perspectives that help us understand the interconnected environments in which military children live their lives, from the dynamics of the family system itself to the external contexts of the communities where they live and the military culture that helps form their identity. The authors conclude that policy makers can help military-connected children and their families cope with deployment by, among other things, strengthening community support services and adopting public health education measures that are designed to reduce the stigma of seeking treatment for psychological distress. They warn, however, that much recent research on military children's response to deployment is flawed in various ways, and they call for better-designed, longer-term studies as well as more rigorous evaluation of existing and future support programs.

Multiple adjustment difficulties have been associated with children's exposure to recent parental wartime military deployments, but long-term consequences have not yet been systematically studied. This investigation will assess direct and indirect relationships between exposures to parental deployments early in life and later youth adjustment. Parents' psychological health and family processes will be examined as mediators, and parents' and children's vulnerability and support will be examined as moderators. Archival data will be combined with new data gathered from two children and up to two parents in families where children will be aged 11 to 16 at the first data collection and will have experienced at least one parental deployment, for at least one child prior to age 6. Data are being gathered via telephone interviews and web-based surveys conducted twice one year apart. Outcomes are indicators of children's social-emotional development, behavior, and academic performance. Notable features of this study include oversampling of female service members, inclusion of siblings, and inclusion of families of both veterans and currently serving members. This study has potentially important implications for schools, community organizations and health care providers serving current and future cohorts of military and veteran families. [ABSTRACT FROM AUTHOR]

Although youth are at risk for exposure to adversity and trauma, many youth, especially ethnic and racial minorities, do not have access to mental health care. Resilience-building curriculums can teach important internal resilience skills and provide support to students who may not receive prevention or treatment services. We adapted a resilience curriculum initially used for military-connected youth facing adversities related to parental wartime deployments, to meet the needs of low-income, predominantly racial and ethnic minority students in a large urban school district. In this article, we describe the cultural adaptation, the implementation process, and the evaluation of the trauma-informed resilience curriculum using pre-post surveys and focus group discussions. We found significantly improved overall internal resilience scores, as well as significantly improved scores on subscales of problem-solving and empathy among students receiving the curriculum. The focus groups revealed that the curriculum enhanced connections among students, as well as students and teachers, and served as a way to destigmatize mental health issues. The acceptability of the curriculum as well as implementation successes and challenges are described. We provide suggestions for future steps for school psychologists and school social workers for implementing this curriculum.

Pediatric cancer can disrupt the behavioral and emotional well-being of youth and their families, representing a potential psychological health risk for the entire family. Among ethnic minority families, cultural factors such as acculturation and language competency may affect the experience of this illness, which can, in turn, affect overall functioning. Integrating psychological health services within medical care settings is one method to enhance engagement in psychological health services and reduce barriers, including access and stigma. Given the paucity of evidence-based screening procedures and trauma-informed preventive interventions delivered within pediatric settings, the FOCUS consultation model was implemented within an outpatient pediatric oncology clinic. A case illustration is described to highlight the modifications made to the FOCUS consultation model to provide culturally sensitive and responsive treatment to Latino families. The article includes implications for future research on integrating culturally relevant, family-centered prevention approaches for reaching ethnic minority families.

Mothers living with HIV (MLH) are at high risk for acute and chronic stress, given challenges related to their HIV status, ethnicity, economic and urban living conditions. Biomarkers combined into a composite index show promise in quantifying psychosocial stress in healthy people, but have not yet been examined among MLH. According, we examined potential biomarker correlates of stress [cortisol and catecholamines from home-collected urine and basic health indicators (blood pressure, height and weight, waist-to-hip ratio) measured during an interview] among 100 poor African American and Latina mothers MLH and demographic-matched control mothers without HIV (n = 50). Participants had been enrolled in a randomized controlled trial about 18 months earlier and had either received (MLH-I) or were awaiting (MLH-W) the psychosocial intervention. Participation was high, biomarkers were correctly collected for 93% of cases, and a complete composite biomarker index (CBI) calculated for 133 mothers (mean age = 42). As predicted, MLH had a significantly higher CBI than controls, but there was no CBI difference across ethnicity or intervention group. CBI predicted CD4 counts independently after controlling for age, years since diagnosis, prior CD4 counts, medication adherence, and depression symptoms. The study demonstrates acceptability, feasibility and potential utility of community-based biomarker collections in evaluating individual differences in psychosocial stress.

Background: A significant number of pediatric heart transplant recipients and their families experience post‐traumatic stress symptoms following transplantation, which can impact recipient behavioral and medical health outcomes. Preventive behavioral health interventions may improve outcomes, especially if interventions can be delivered at a distance to decrease barriers to mental health care. This pilot study examined the acceptability and accessibility of an evidence‐informed resilience training program delivered using a video telehealth platform. A secondary aim was to assess the preliminary efficacy of the intervention on recipient behavioral health outcomes, perceived barriers to recipient medication adherence, parent behavioral health outcomes, and family functioning. Methods: Seventeen heart transplant recipients (8–18 years old) and their families were recruited and randomly assigned to a treatment as usual (n = 8) or an intervention group (n = 9). Baseline assessment data collected included demographic information and validated behavioral health measures. Follow‐up assessments included the validated measures and acceptability and satisfaction ratings. Results: The study demonstrated that the program has high acceptability by recipients and parents, and a positive impact on recipients and parents, including significant reductions in youth behavioral difficulties as well as parent depression and post‐traumatic stress symptoms. Conclusions: Results of this study are promising and call for further evaluation of hybrid delivery models for behavioral health screening and prevention interventions for pediatric heart transplant recipients and their families. [ABSTRACT FROM AUTHOR]

Military children encounter unique stressors that can affect their social and emotional well-being. These challenges can serve as a risk to the military child's successful academic performance. This study fills a much-needed research gap by examining the training and implementation of a public school-based intervention, Families OverComing Under Stress (FOCUS) School-Based Skill-Building Groups (SBGs). Social work interns from 2 academic years (2011-2012 and 2012-2013) were trained in the implementation of the SBGs. The SBGs aim to promote resilience among students from military families. This study reveals positive findings associated with training the interns. Implementation strengths and challenges are carefully reviewed. Suggestions for the need for school-based interventions are also discussed.

Introduction: Youth in under-resourced communities are more likely to have greater social risk factors for mental health needs yet have less access to needed care. School-based mental health services are effective in treating common disorders such as adolescent depression; however, few have a family-centered approach, which may especially benefit specific populations. Methods: Utilizing a community-partnered approach, we adapted an established, trauma-informed, resilience skill-building family intervention for adolescents with depression. We conducted a small randomized controlled feasibility pilot of an adapted intervention in a large school district that serves predominately low-income, Latinx students in the Southwest United States between 2014-2017. Youth between the ages of 12-18 years old with a Patient Health Questionnaire (PHQ-8) score of 10 or higher, who spoke English or Spanish, were recruited from 12 school mental health clinics. Twenty-five eligible adolescents with depression and their participating caregivers were enrolled and randomly assigned to receive either the adapted intervention, Families OverComing Under Stress for Families with Adolescent Depression (FOCUS-AD), or usual care, Cognitive Behavioral Therapy (CBT) only. Most of the sample was Latinx and female. We evaluated feasibility, acceptability, and preliminary effectiveness. Results: Among participants who completed standardized assessments administered at baseline and approximately five months post-randomization (n = 10 FOCUS-AD, n = 11 CBT only), effectiveness was explored by identifying significant changes over time in adolescent mental health within the FOCUSAD and CBT only groups and comparing the magnitude of these changes between groups. Nonparametric statistical tests were used. We found the FOCUS-AD intervention to be feasible and acceptable; participant retention was high. Adolescent symptoms of depression (measured by the PHQ-8) improved significantly from baseline to follow-up for youth in both FOCUS-AD (median decrease [MD] = 10, p = 0.02) and control (MD = 6, p = 0.01) groups, with no significant difference across the two groups. Results were similar for symptoms of PTSD (measured by the Child PTSD Symptom Scale; FOCUS-AD MD = 12.5, p = 0.01; CBT only MD = 7, p = 0.04; no significant difference between groups). Conclusion: Family-centered approaches to depression treatment among adolescents living in under-resourced communities may lead to improved mental health, although further research is warranted. [ABSTRACT FROM AUTHOR]

Recent studies have confirmed that repeated wartime deployment of a parent exacts a toll on military children and families and that the quality and functionality of familial relations is linked to force preservation and readiness. As a result, family-centered care has increasingly become a priority across the military health system. FOCUS (Families OverComing Under Stress), a family-centered, resilience-enhancing program developed by a team at UCLA and Harvard Schools of Medicine, is a primary initiative in this movement. In a large-scale implementation project initiated by the Bureau of Navy Medicine, FOCUS has been delivered to thousands of Navy, Marine, Navy Special Warfare, Army, and Air Force families since 2008. This article describes the theoretical and empirical foundation and rationale for FOCUS, which is rooted in a broad conception of family resilience. We review the literature on family resilience, noting that an important next step in building a clinically useful theory of family resilience is to move beyond developing broad "shopping lists" of risk indicators by proposing specific mechanisms of risk and resilience. Based on the literature, we propose five primary risk mechanisms for military families and common negative"chain reaction" pathways through which they undermine the resilience of families contending with wartime deployments and parental injury. In addition, we propose specific mechanisms that mobilize and enhance resilience in military families and that comprise central features of the FOCUS Program. We describe these resilience-enhancing mechanisms in detail, followed by a discussion of the ways in which evaluation data from the program's first 2 years of operation supports the proposed model and the specified mechanisms of action. (Contains 2 figures, 1 table, and 2 footnotes.)

Objective: Given the growing number of military service members with families and the multiple combat deployments characterizing current war time duties, the impact of deployments on military children requires clarification. Behavioral and emotional adjustment problems were examined in children (aged 6 through 12) of an active duty Army or Marine Corps parent currently deployed (CD) or recently returned (RR) from Afghanistan or Iraq. Method: Children (N = 272) and their at-home civilian (AHC) (N = 163) and/or recently returned active duty (AD) parent (N = 65) were interviewed. Child adjustment outcomes were examined in relation to parental psychological distress and months of combat deployment (of the AD) using mixed effects linear models. Results: Parental distress (AHC and AD) and cumulative length of parental combat-related deployments during the child's lifetime independently predicted increased child depression and externalizing symptoms. Although behavioral adjustment and depression levels were comparable to community norms, anxiety was significantly elevated in children in both deployment groups. In contrast, AHC parental distress was greater in those with a CD (vs. RR) spouse. Conclusions: Findings indicate that parental combat deployment has a cumulative effect on children that remains even after the deployed parent returns home, and that is predicted by psychological distress of both the AD and AHC parent. Such data may be informative for screening, prevention, and intervention strategies. (Contains 3 figures and 5 tables.)

The present study investigated how maternal HIV and mediating family processes are associated with adolescent distress, substance use, and risky sexual behavior. Mother-adolescent (ages 12-21) dyads (N = 264) were recruited from neighborhoods where the HIV-affected families resided (161 had mothers with HIV). Mediating family processes were youth aggressive conflict style, maternal bonding, maternal role reversal expectations, and overall family functioning. Results of structural equation modeling indicated that youth aggressive conflict resolution style was strongly associated with adolescent distress, substance use, and risky sexual behavior. In HIV-affected families, youth less frequently reported using an aggressive conflict resolution style and more frequently reported positive maternal bonds; their mothers reported less positive family functioning than control families. Finally, maternal distress indirectly affected adolescent distress and risk behavior via youth aggressive conflict resolution style. (Contains 2 tables and 1 figure.)

The longitudinal impact of a family-based intervention on grandchildren of parents with HIV (PWH) is evaluated. Because PWH and their daughters demonstrated gains over 6 years when randomized to a coping skills intervention compared with a control condition, the adjustment of the PWH's grandchildren was also compared across conditions. Grandchildren in the intervention condition reported significantly fewer internalizing and externalizing behavioral symptoms compared with grandchildren in the control condition. There is weak evidence that grandchildren in the intervention condition had higher scores on measures of cognitive development and more positive home environments. These results suggest that there are possibly long-term, intergenerational benefits of an intervention for families coping with HIV.

The effects of combat deployment to Iraq or Afghanistan of US Army or Marine Corps personnel on their children and spouses are studied. Parental combat deployment has a cumulative effect on children, including child depression and externalizing symptoms, that remains after the parent returns from deployment.

The impact of parental substance use on the emotional and behavioral adjustment of their adolescent children was examined over 5 years. A representative sample of 220 parents with HIV (PWH) and 330 adolescent children in New York City were repeatedly assessed. Some parents never used marijuana or hard drugs over the 5 years (nonusers). Among those who were users, substance use varied over time. PWH who used substances during a specific 3-month period were classified as active users and those who abstained from substance use were classified as inactive users. Longitudinal regression analyses were used to analyze the impact of variations in patterns of substance use over time on their adolescent children's emotional adjustment and behavioral problems. PWH relapse exacerbated adolescent substance use, trouble with peers, and adolescent emotional distress. Even time-limited reductions in parents' substance abuse can have a significant positive impact on their adolescent children's emotional and behavioral adjustment. Interventions that address parental substance use among PWH should be developed to ameliorate the impact of substance use relapse on their adolescents. Keywords: substance abuse, HIV, parenting, adolescent development, relapse

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1545-5300.2007.00214.x Byline: JUDITH A. STEIN ([dagger]), MARY JANE ROTHERAM-BORUS ([double dagger]), PATRICIA LESTER ([double dagger]) Keywords: Parentification; Parents With AIDS; Adaptive Coping; Parental Death Abstract: Stein, Riedel, and Rotheram-Borus reported in 1999 that early parentification predicted maladaptive outcomes of more emotional distress, substance use, and conduct problems among adolescents of parents with HIV/AIDS (PWH) 6 months later. The current study assessed the adolescents (N=213) 6 years later to assess whether there were continuing negative effects of parentification, or, rather, if there were some positive outcomes. Although the premature assumption of parental roles had negative effects in the short term, we hypothesized that such skills may have been adaptive in the long run, especially in the case of adolescents with major stressors in their lives, including dying or ill parents, impoverished environments, and family instability. We found that early parentification predicted better adaptive coping skills and less alcohol and tobacco use 6 years later. In addition, early parentification was not associated with later emotional distress and dysfunctional parenting attitudes, including expecting role reversals in their own children. Author Affiliation: ([dagger])Department of Psychology, UCLA. ([double dagger])Department of Psychiatry and Biobehavioral Sciences, UCLA.

The impact of HIV-related parental death on 414 adolescents was examined over a period of 6 years. The adjustment of bereaved adolescents was compared over 4 time periods relative to parental death and was also compared with the adjustment of nonbereaved adolescents. Bereaved adolescents had significantly more emotional distress, negative life events, and contact with the criminal justice system than nonbereaved youths; these behaviors did not remain significantly higher after parental death. Depressive symptoms and passive problem solving increased soon after parental death, as compared with nonbereaved adolescents. One year subsequent to parental death, depression and passive problem solving were similar to the levels of nonbereaved peers. Only sexual risk behaviors increased following parental death. These results suggest the importance of early family intervention soon after parental HIV diagnosis, prior to parental death, and sustained over time.

There is a necessity of scaling up antiretroviral (ARV) treatment programs in the developing nations of the world. The challenges inherent in efforts to scale up ARV treatment programs are discussed.

"Families OverComing Under Stress" (FOCUS) Resilience Curriculum for Parents (FRC-P) is a trauma-informed group parenting program adapted for school social workers to deliver to parents of racial/ethnic minority urban public schoolchildren, an under-researched group of parents in the literature. The objective was to describe implementation of the pilot FRC-P in terms of possible effectiveness, feasibility, and acceptability. Social workers delivered FRC-P to parents at 16 schools. We analyzed (1) changes in parent well-being; (2) parent satisfaction; and (3) a focus group of participating social workers. Ninety-six of 261 parents (37%) who attended FRC-P completed pre and post surveys. Parents reported significant improvements (p <.01) in family functioning (Cohen's d = 0.41), parent connectedness (d = 0.71), and social support (d = 0.66). Social workers linked parents to needed services. Parents and social workers found FRC-P feasible and acceptable. With refinement, FRC-P could help schools foster resilience in under-resourced parents. [ABSTRACT FROM AUTHOR]