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The purpose of this study was to explore the experiences of six heterosexual couples who identified as being in a mixed ethnic and/or racial marriage where one partner is of Latino/a descent and the other is of non-Latino/a White descent. There are virtually no studies that investigate this type of cross-cultural marriage. Therefore, this exploratory pilot study provides some in-depth descriptions of how these couples experience their interethnic relationships. A set of open-ended questions was sent to couples living throughout the United States and a follow-up phone call was conducted with each person for member checking purposes and to give participants an opportunity to elaborate on their responses. The primary categories that emerged from the data are: (1) the experiences and perceptions of being in a marriage with someone from a Latino/a or Euro-American ethnic group, (2) the perceived reactions from family, friends and social institutions, and (3) the perceived levels of acculturation and multiculturalism. [ABSTRACT FROM AUTHOR]

The purpose of this study is to advance our understanding of how doctoral students perceive postmodernism's influence in the field of Marriage and Family Therapy (MFT). According to the literature, postmodernism has had a profound impact on many fields, including MFT. However, tracking of how postmodernism is actually being rendered in theory, research, practice, and training warrants investigation. This study utilized focus group interviews to investigate the perceptions of MFT doctoral students. Findings suggest that while participants are attracted to postmodern tenets, they also report feeling a mixture of liberation and excitement with confusion and fear regarding how postmodernism is influencing MFT models of therapy. [ABSTRACT FROM AUTHOR]

Cambodian refugees resettled in the United States were severely affected by genocidal trauma and have been trapped in decades of intergenerational transmission of traumatic stress and relational disruptions without much public attention. This manuscript reports on data collected as part of a Cambodian needs assessment that employed methodological principles of critical ethnography and was grounded by a human ecological theoretical model. Eighteen professionals who served Cambodian communities were interviewed. The interviews were transcribed in Khmer or/and English and analyzed using the Developmental Research Sequence resulting in three domains (Pre-Migration, During Migration, and Post Resettlement in the United States) and four categories (i.e. Impact on Self, Couple Relationships, Parent-Child Relationships, and Context) within each domain. The thematic findings emphasize intergenerational transmission of psychopathology, disruptions in parent-child relationships, and a critical need to support parents to promote positive child development within Cambodian communities., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Despite experiencing disproportionately high rates of trauma exposure and traumatic stress, sexual and gender minority populations are underrepresented in research on posttraumatic growth (PTG). Data from two waves of semistructured life review phenomenological interviews with 14 sexual minority women and nonbinary individuals were analyzed to explore sexual minority women and nonbinary individuals' lived experiences of growth and healing from exposure to traumatic events. Three main themes were identified: (1) healing through interpersonal connection; (2) new learning about the self and relationships; and (3) healing as political. The first theme describes the central role of interpersonal connection; whereas some participants described seeking and receiving social support from others, most discussed the value of healing with others. The second theme characterizes new learning following trauma, such as learning that, in healthy and safe relationships, one can be loved for who they are. The third theme encompasses how participants politicized their PTG and that even the process of politicizing the traumatic experience itself facilitated growth, as participants understood their struggle as connected to larger systems of oppression, contributing to further identity development. Our findings suggest that sexual minority women and nonbinary individuals experience PTG as a political, iteratively individual and relational process of queer worldmaking (Berlant & Warner, 1998). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exposure to potentially traumatic events and posttraumatic stress are known risk factors for suicidal thoughts and behaviors (STB). Research suggests that sexual minorities are disproportionately exposed to traumatic events and experience greater STB than their heterosexual peers, although few studies have explored connections between these parallel disparities. Further, existing literature may implicate complex posttraumatic stress disorder (CPTSD) as a potential mechanism in the trauma-suicide connection among sexual minorities. This study uses a sample from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III; n  = 1351) to test structural equation models for associations between trauma exposure, heterosexist discrimination, and CPTSD with suicide attempt status. We found CPTSD mediated associations between exposure to traumatic events and presence of a lifetime suicide attempt among sexual minority male and female samples. Discrimination demonstrated a synergistic effect on the association between trauma exposure and CPTSD, but, among males, CPTSD did not fully explain associations between discrimination and suicide attempts. Our findings suggest that CPTSD should be considered an important mechanism in the trauma-suicide connection for sexual minorities and may be a potentially important target for suicide prevention and that interventions should address the influence of discrimination on traumatic stress in this high-risk population.

The United States has a long history of welcoming refugees fleeing persecution, organized violence, and war. However, the welcome often does not come with adequate immigration infrastructure support necessary to rebuild life and promote family well-being. Approximately 157,000 Cambodians were accepted to resettle in the U.S. between 1975 and 1994 due to the countrywide genocide. Upon resettlement, Cambodians were placed in impoverished neighborhoods with little resources to heal and rebuild. The purpose of this study, grounded in a Human Ecological Model and guided by Critical Ethnography principles, was to conduct a formal needs assessment of Cambodian refugee families across the United States. Eighteen professionals were interviewed virtually in Khmer and/or English. The data were analyzed using the Developmental Research Sequence. The results emphasized a critical need to address mental health complications resulting from untreated mental health disorders such as posttraumatic stress, depression, anxiety-related disorders, and complicated grief, across generations. Severe disruptions in family relationships (i.e., parent-child and couple relationships) were also reported along with substance abuse in the absence of access to culturally responsive mental health treatments. Findings suggest the need for culturally tailored multilevel interventions to effectively address mental health and relational challenges of multigenerational Cambodian families.

The COVID-19 pandemic was a socionatural disaster that unprecedentedly disrupted the daily lives of individuals, families, and communities. Prior research indicates that Black American men living in rural contexts, particularly in Southern parts of the United States of America, were disproportionately affected by the psychological and economic effects of the pandemic. Despite these disparities, few studies have examined the pandemic's impact on rural Black American men's social networks. This study aimed to explore the effects of the COVID-19 pandemic on rural Black American men's interpersonal relationships. Informed by the principles of critical ethnography and guided by van Manen's hermeneutic phenomenology, seventeen men were interviewed using a semi-structured interview protocol. Interviews were transcribed and then analyzed using an iterative thematic reduction process consistent with van Manen's approach. Four themes were generated: Familial Reorganization, Adaptive Fatherhood, Rona Romance, and Essential Community. Participants recounted how the pandemic motivated them to improve their relationships with family members and children but contributed additional stress to their romantic relationships. Participants further recounted how their friendships were the least impacted as they were willing to make exceptions to their normal protective protocols to socialize with close friends. Participants also noted feeling disconnected from their wider community because they could not attend church even though their religious beliefs remained unchanged. Findings highlight the need for scholars, clinicians, and policymakers to consider men's relational health when developing and implementing pandemic recovery efforts, as it can significantly influence their ability to recuperate mentally and physically. Future research should be dedicated to (1) investigating the effects of the COVID-19 pandemic on fathers, as prior research has nearly exclusively focused on mothers' experiences and (2) delineating protective effects of rural Black American men's involvement in the Black Church from their individual spiritualities to gain a more comprehensive understanding of the influence of contextual crisis on their long-term health and wellbeing., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Curtis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Studies show that war leads to an increase in harsh parenting and a decrease in parental warmth, which in turn has a devastating impact on children's development. However, there is insufficient research on the factors that affect parenting in post-conflict regions. In addition, most previous studies on the role of parenting in the context of war rely on self-reports, which are subject to a number of limitations. To complement existing research, the present cross-sectional study used behavioral observations of 101 mothers and their 6-12 year old children to assess parenting in post-conflict northern Uganda. The aim of the current study was to explore associations between observed maternal warmth and coercion and self-reported socioeconomic status (e.g., mother's educational level) as well as maternal (e.g., posttraumatic stress disorder), child (e.g., externalizing problems), and social contextual factors (e.g., family violence). Results show a link between observed parenting, child characteristics, and family violence. Higher levels of children's externalizing problems were associated with more severe maternal coercion. In addition, a negative association was found between family violence and maternal warmth. Findings are discussed in terms of their implications for prevention and intervention programs and the use of behavioral observations in post-conflict environments.

Family connections are crucial for trauma-affected refugees from collectivistic cultures. Evidence-based family interventions are consistently promoted to support a host of mental and relational health needs of families exposed to traumatic stressors; however, there is still limited research focused on cultural adaptation and the testing of the effectiveness of these interventions on some of the most disenfranchised populations in the aftermath of forced displacement. This systematic review was conducted to examine the reach of existing evidence-based family interventions implemented with newly resettled refugees globally. Studies included in this review include those testing the effectiveness of a systemic treatment with pre and post intervention evaluation, studies with or without control groups, and studies that include at least one family member in addition to the target participants. Twelve studies met the inclusion criteria. Barriers to conducting randomized control trials with displaced refugee populations are discussed. Recommendations are made for future studies to include a focus on scientifically rigorous multi-method designs, specific cultural adaptation frameworks, and the integration of relational aspects rather than focusing only on individual adjustment. Global displacement continues to rise; therefore, it is imperative that the mental health and wellbeing of displaced populations be treated with a comprehensive, multi-level framework.

Over the past few decades, there has been a growing interest among systemic researchers and clinicians to address issues related to psychological traumatic stress. Yet, research in this area has largely focused on intrapersonal and physiological processes in conceptualizing traumatic stress and its various outcomes. Despite the usefulness of intrapersonally focused models of traumatic stress, this approach has its limitations. Emerging evidence indicates that both proximal contexts, such as family, and distal socioecological contexts, such as political and environmental systems, can have a profound effect on traumatic stress risk, presentation, and recovery. In the present article, we review and synthesize emerging research on traumatic stress and integrate findings from intrapersonally and systemically focused models of traumatic stress. We propose and present evidence for what we term the dynamic socioecological framework of traumatic stress, a heuristic framework for conceptualizing the interactions between different forms of traumatic stress. This framework puts forward the dimensions of traumatic stress typology, severity, and timing, underscoring how traumatic stress risk, presentation, and recovery are highly dependent upon the systems in which people are embedded. We conclude with a discussion of the research and clinical implications of this conceptual framework., (© 2021 Family Process Institute.)

The Acholi people of northern Uganda experienced decades of conflict. Alcohol misuse is high among northern Ugandan men. This is common in displaced or post-war communities. Because parents are often the most significant and proximal influence in a child's development, it is important to understand the relationships between parental behavioral health and parenting. The purpose of this ethnographic study was to understand the impact of alcohol misuse on fathering, from fathers' perspectives. We collected qualitative data from several sources, including in-depth interviews with 19 fathers. Informants identified three ways in which a father can "overdrink": drinking to drunkenness, spending too much money on alcohol, or spending too much time drinking alcohol. Fathers described the specific ways in which overdrinking impacted each of the three primary roles of a father, which were identified as providing, educating, and creating a stable home. Of the negative effects of overdrinking, a compromised ability to provide for basic needs was described as the most salient. The findings suggest that support for families in this region should include support for father's substance misuse, as a father's overdrinking is widely understood to be problematic for the entire family.

The family therapy literature documenting the experiences of couple/marriage and family therapists (C/MFTs) of color as a group is limited. The purpose of this study was to assess the status of C/MFTs of color in their clinical training programs, clinical work, and related areas of professional challenges and opportunities. Participants (N = 113) completed a one-time, anonymous electronic survey on SurveyMonkey consisting of demographic questions, closed- and open-ended questions about their experiences. Key findings are reported related to C/MFTs of color experiences in training programs, areas of professional need, and working with racial and/or ethnic minority clients. These findings shed light on how social justice principles and practices upheld in our field are experienced from the emic perspectives of C/MFTs of color. These voices help to broaden our understanding of how we might move forward in advocating for and advancing a more culturally responsive agenda within our profession., (© 2020 American Association for Marriage and Family Therapy.)

Background: Family violence has been shown to have a dramatic impact on individual and family life in the United States and other countries. Numerous studies have assessed the influence that exposure to violence can have on family dynamics and parent-child relationships. However, less is known about the association between family violence and parent-child relationships with Mexican families., Objective: Guided by social interaction learning theory, the purpose of this study was to explore the role of exposure to family violence on PTSD and mother-child interaction patterns., Methods: Eighty-seven mother-child dyads from Mexico completed assessments for exposure to family violence, PTSD, and observational tasks were analyzed to assess prosocial parent-child interactions (i.e., positive communication and problem solving). We conducted an actor-partner independence model (APIM) to examine the association between exposure to family violence, PTSD and mother-child relationship dynamics., Results: As expected, higher exposure to family violence was linked to higher PTSD symptoms for mothers. Unexpectedly, higher maternal PTSD symptoms were associated with better communication during dyadic interaction tasks with their children., Conclusions: The present study suggests that individuals from certain cultures (i.e., Mexico) may respond differently to experiencing family violence. The use of multiple measurement methods to assess the relational effects of trauma on family dynamics can advance the scientific understanding of trauma affected families., Competing Interests: Conflicts of interest/competing interests: We have no conflict of interests to report at this time. Consent to participate: We obtained informed consent from all participants prior to the study. Consent for publication: Study participants were made aware that data would be used for publication and that no personal identifiers would be included in the manuscript.

The status of immigrant families resettled to the United States in the past decade has been fraught with upsurges of governmental policies that have systematically increasing the levels of oppression, violence, and abuses of human rights. The socio-political-economic toll of xenophobic practices on specifically targeted immigrant populations is magnified by the psychological and relational impact they have on individuals, families, and communities. This manuscript is conceptualized as an ongoing call for social action and specific mobilization by mental health professionals in response to the increasing threats to civility and dignity faced by various immigrant communities. The paper is organized in three sections: (a) an overview of the effects of immigration policy on immigrant family experiences; (b) the impact of mental and relational health on immigrant populations; and (c) elaborations of three exemplar community projects designed to support immigrant families. The manuscript concludes with a discussion exploring avenues for promoting a stronger base for solidarity and social action., (© 2020 American Association for Marriage and Family Therapy.)

Citizens of the Democratic Republic of Congo (DRC) experienced widespread torture during national wars between 1998 and 2003. Couples who survived and stayed intact suffered tremendous relationship stress. This study used a critical ethnography framework to explore the prewar, wartime, and postwar experiences of 13 torture-surviving couples who participated in a 10-session Torture-Surviving Couple Group in 2008 in the DRC. The group was designed to address the relational effects of torture and war trauma. Participants reported profound negative effects of the war on their relationships; mostly positive experiences during the group, including marital and peer connection and relationship growth; and a number of improvements in their relationship after the group. Implications include support for the use of relational interventions informed by both treatments for traumatic stress and couple approaches to promote trauma healing. Future directions call for increased funding, research, training, and clinical action to treat the effects of traumatic stress on relational family dynamics., (© 2019 Family Process Institute.)

An increasing number of culturally adapted family-level interventions address mental health disparities with marginalized populations in the United States. However, with these developments many barriers have arisen, such as challenges with degree of cultural fit, engagement, and sustainability. We conducted 12 elite phenomenological interviews with mental health scholars involved in prevention and intervention family research with various Latinx communities within and outside of the United States. These scholars discussed their experiences of overcoming barriers in their research. We used thematic analysis to code and analyze participant responses, and our findings support the gaps in previous literature and highlight potential pathways to overcoming barriers in cultural adaptation research. Themes included the need for: (a) better understanding of the intersection between culture and context; (b) community-centered approaches to addressing implementation challenges; and (c) structural changes within institutional, governmental, and political levels. We discuss implications for researchers and practitioners working with Latinx families., (© 2019 Family Process Institute.)

Experiencing violence changes behavior, shapes personalities, and poses a risk factor for mental disorders. This association might be mediated through epigenetic modifications that affect gene expression, such as DNA methylation. The present study investigated the impact of community and domestic violence on DNA methylation measured in saliva collected from 375 individuals including three generations: grandmothers (n = 126), mothers (n = 125), and adolescents (n = 124, 53% female). Using the Infinium HumanMethylation450 BeadChip array, in adolescents, we detected two CpG sites that showed an association of DNA methylation and lifetime exposure to community and domestic violence even after FDR correction: BDNF_cg06260077 (logFC -0.454, p = 3.71E-07), and CLPX_cg01908660 (logFC = -0.372, p = 1.38E-07). Differential DNA methylation of the CpG BDNF_cg06260077 associated with exposure to violence was also observed in the maternal but not the grandmaternal generation. BDNF (brain-derived neurotrophic factor) and CLPX (caseinolytic mitochondrial matrix peptidase chaperone subunit) genes are involved in neural development. Our results thus reveal altered molecular mechanisms of developmental and intergenerational trajectories in survivors of repeated violent experiences., (© 2019 The Authors Psychophysiology published by Wiley Periodicals, Inc. on behalf of Society for Psychophysiological Research.)

Traumatic stress can have detrimental effects on individuals, families, and communities. Narrative Exposure Therapy (NET) is an evidence-based intervention for decreasing individuals' posttraumatic stress disorder (PTSD) symptoms and has been tested in some of the most challenging contexts, such as in post-conflict refugee camps. Although the focus of NET is on reducing individual PTSD symptoms, the impact of NET can be seen beyond the individual level. The purpose of this manuscript was to examine some of the ecological implications of using NET with trauma-affected populations in low-resource settings. We highlight select implications of NET that extend beyond the individual to systemic effects at the family, community, and sociopolitical levels using several case examples. Finally, we outline limitations and future directions for improving the delivery of NET in settings with limited resources.

There is growing interest in causes and consequences of disruptions in parent-child relationships in post-war environments. Recent studies mainly relied on self-reports to gain information about family dynamics following war exposure. Considering the limitations of self-report measures, we see the need for an in-depth examination of post-conflict parenting based on observational and quantitative data. The aim of the present study was the development of a coding system for a culturally bound description of parent-child interactions in northern Uganda, where virtually the entire population has been severely affected by 20 years of civil war. Interactions of 101 mothers and their 6- to 12-year-old children were observed during a structured interaction task (problem solving discussion). Foundation for the development of the coding system was the Family and Peer Process Code (FPP code). The cultural adaptation of the FPP code was based on in-depth qualitative analyses of the problem solving task, including a combination of inductive and deductive latent content analyses of textual data and videotapes, member checking and consultations of experts in the field of behavioral observations. The final coding system consists of 35 exhaustive and mutually exclusive content codes including codes for verbal, vocal, and compliance behavior as well as 14 affect codes. Findings indicate that the assessment of behavioral observations in post-conflict settings provides unique insights into culture- and context-specific interaction patterns and may be critical for the development and evaluation of parenting interventions., (Copyright © 2019 Möllerherm, Wieling, Saile, Forgatch, Neuner and Catani.)

Background: Despite the large number of evidence-based practices (EBPs) ready for implementation, they are the exception in usual care, especially for ethnic minority patients, who may not have access to trained health professionals. Providing EBP training as part of a graduate curriculum could help build the pipeline of professionals to provide quality care., Methods: We conducted a before-after study to determine whether we could implement a blended learning strategy (BL; i.e., in vivo and online training) to teach an EBP in university settings. Feasibility in this pilot was operationalized as knowledge acquisition, satisfaction, fidelity, acceptability, and usability. Using GenerationPMTO as the EBP, our aim was to train graduate students enrolled in Psychology, Social Work, and Family Therapy programs in the EBP in one academic year. Two therapists from a community agency were also students in this pilot. A total of 13 students from five universities were trained in the intervention. Adaptations were made to the intervention and training strategy to optimize training fidelity. Focus groups were conducted with the students to capture their perspective about the training., Results: Students demonstrated significant knowledge acquisition from baseline (Mean = 61.79, SD  = 11.18) to training completion (Mean = 85.27, SD  = 5.08, mean difference = - 23.48, 95% CI = - 29.62, - 17.34). They also reported satisfaction with the BL format, as measured by teaching evaluations at the end of the course. Instructors received acceptable fidelity scores (range of 7-9 in a 9-point scale). Qualitative findings from focus groups showed support for acceptability and usability of BL training., Conclusions: BL training in university settings can be conducted with fidelity when provided by appropriately trained instructors. BL that integrates EBP and adaptations may be uniquely applicable for training providers in low-resource and ethnically diverse settings. The BL enhanced knowledge of GenerationPMTO was acceptable and usable to students, and was delivered with high instructor fidelity to the training model., Competing Interests: Competing interestsThe authors declare that they have no competing interests.

Parenting programs are an effective strategy to prevent multiple risky outcomes during adolescence. However, these programs usually enroll one caregiver and have low attendance. This study evaluated the preliminary results, cost, and satisfaction of adaptive recruitment and parenting interventions for immigrant Latino families. A mixed methods study was conducted integrating a pre-post design with embedded qualitative and process evaluations. Fifteen immigrant Latino families with an adolescent child aged 10-14 were recruited. Two-caregiver families received a home visit to increase enrollment of both caregivers. All families participated in an adaptive parenting program that included group sessions and a one-to-one component (online videos plus follow-up telephone calls) for those who did not attend the group sessions. The intervention addressed positive parenting practices using a strengths-based framework. Primary outcomes were the proportion of two-parent families recruited and intervention participation. Secondary outcomes were change in parenting self-efficacy, practices, fidelity, costs, and satisfaction. Participants completed questionnaires and interaction tasks before and after participating in the intervention. In addition, participants and program facilitators completed individual interviews to assess satisfaction with the program components. Overall, 23 parents participated in the intervention; 73% of two-parent families enrolled with both parents. Most participants completed 75% or more of the intervention. Fathers were more likely to use the one-to-one component of the intervention than mothers (p = .038). Participants were satisfied with program modifications. In sum, adaptive recruitment and parenting interventions achieved high father enrollment and high participation. These findings warrant further evaluation in randomized trials.

In this article, we present development and feasibility of implementation of a multi-couple group for use with torture-surviving couples. The model was developed in the Democratic Republic of the Congo in a community that experienced widespread torture during the wars from 1998 to 2004. The Torture-Surviving Couple Group model is a short-term intervention designed to use few human resources to address relational difficulties resulting from exposure to traumatic stressors. The model was guided by critical and feminist epistemologies and employed an ecological lens to incorporate neurobiology and attachment processes along with narrative therapy techniques. An existing multi-couple group model for addressing violence (Stith, Rosen, McCollum, & Thomsen, ), and a stage model for healing trauma (Herman, ) also informed the structural development of the Torture-Surviving Couple Group model. Couple groups were conducted using a 10-session program with 13 couples who met weekly. Session themes were incorporated into four phases emphasizing: (a) preparation; (b) safety and stabilization; (c) processing the relationship effects of trauma and grief; and (d) reintegration and rebuilding couple and family life. Couples reported and showed remarkable progress in their relationships after participating in the groups. Clinical and research implications and discussed along with the feasibility of developing and testing the model in a post-conflict low income setting., (© 2017 American Association for Marriage and Family Therapy.)

Parents and children exposed to war and relocation have high rates of negative relational and mental health outcomes. This study tested the feasibility of implementing an adapted evidence-based parenting intervention for contexts of trauma and relocation stress. Eleven Karen refugee caregivers from Burma participated in the intervention. Participants and a focal child completed ethnographic interviews as well as structured assessments at baseline and follow-up. Caregivers reported changes in their teaching, directions, emotional regulation, discipline, and child compliance. Children reported changes in these areas and in positive parent involvement. Caregivers reported higher mental health distress immediately after the intervention, potentially due to increased awareness. Researchers made personalized referrals for counseling services as needed. Children reported a decrease in mental health symptoms., (© 2017 American Association for Marriage and Family Therapy.)

Pregnant and parenting adolescents experience high rates of intimate partner violence (IPV) and its sequelae posttraumatic stress disorder (PTSD) and depression. Narrative exposure therapy (NET) is an innovative intervention that has demonstrated strong preliminary evidence in improving mental health. The specific aims of this article are 3-fold: (1) provide a brief background about IPV-related PTSD and depression among pregnant and parenting adolescents; (2) describe NET's theoretical principles, its therapeutic process, and provide a review of existing evidence; and (3) discuss NET as a potential treatment to address the mental health burden among adolescents experiencing IPV-related PTSD and depression.

In this article, we discuss the successful implementation of an adapted evidence-based parenting intervention for families affected by two decades of war in Northern Uganda. The adaptation and adoption of such interventions to support mental health and family functioning is widely endorsed by prevention scientists and considered a priority in global mental health. The preparation and early adoption phases of engaging with a highly vulnerable community affected by war trauma are documented in this paper along with a discussion of the steps taken to adapt a parenting intervention for cultural and contextual fit. This study is a component of an overall program of research aimed at reducing the long-term negative effects of war on parenting practices and childhood outcomes, which have considerable implications for preventing mental, neurological, and substance-use disorders. The processes described here cover a 4-year period culminating in the implementation of the nine-session Enhancing Family Connection intervention piloted with a group of 14 mothers. The lessons in cultural adaptation have been valuable and the feasibility results promising for further testing the intervention., (© 2015 Family Process Institute.)

This research examined the experiences of families living with a child with severe autism. There is limited literature on the experiences of families when a child has severe autism as distinct from milder autism and includes the voices of multiple family members. Van Manen's phenomenological approach was used for data collection and analysis. This approach allowed for the use of innovative data sources, including unstructured individual and family interviews, observations, and family lifelines (a pictorial, temporal picture with comments of the families lives). This study included 29 interviews with 22 participants from 11 families. All data were creatively triangulated and interpreted. Six essential themes were identified. First, families experienced autism as mysterious and complex because it is an invisible and unpredictable condition with diagnostic challenges. Second, families described severe autism behaviors that often caused self-injury, harm to others and damaged homes. Third, profound communication deficits resulted in isolation between the family and child. Fourth, families discussed the unrelenting stress from lack of sleep, managing the child's developmental delays, coordinating and financing services, and concern for the child's future. Fifth, families described consequences of isolation from friends, school, the public, and health providers. Sixth, families portrayed their need for compassionate support and formed 'hybrid families' (nuclear, extended families and friends) to gain support. Study results can be utilized to educate nurses/other providers about the unique needs of families with children with severe autism and could influence health care policies to improve the care for families caring for children with severe autism., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Community-based participatory research (CBPR) can help increase the attendance in community programs. Padres Informados, Jovenes Preparados (PIJP) is a program that aims to prevent tobacco and other substance use among Latino youth by promoting positive parenting. Although the trial used CBPR approaches, attendance was inconsistent. In the present study, factors associated with attendance and nonattendance and recommendations to maximize participation were explored in 12 brief feedback discussions (BFDs) with participants and in 10 in-depth interviews (IDIs) with facilitators who delivered PIJP. Content analysis guided two pairs of researchers, who independently coded emerging themes and categories (κ = .86 for BFDs and .73 for IDIs). Data from BFDs and IDIs were merged and interpreted together. We grouped factors that positively affected participation into three categories: individual and family (e.g., motivation), program (e.g., offering food and childcare and having facilitators who are trusted), and research (e.g., having incentives). Barriers to participation were grouped into four categories: individual and family (e.g., family conflicts), sociocultural (e.g., community and cultural beliefs), program (e.g., fixed schedules), and research (e.g., recruitment procedures). Participants provided recommendations to address all types of barriers. Although PIJP used CBPR, complete satisfaction of community needs is difficult. Effective community programs must address participants' needs and preferences., (© 2015 Society for Public Health Education.)

In this manuscript, we describe the initial steps of an international program of prevention research in Monterrey, México. Specifically, we present a feasibility study focused on exploring the level of acceptability reported by a group of Mexican mothers who were exposed to a culturally adapted parenting intervention originally developed in the United States. The efficacious intervention adapted in this investigation is known as Parent Management Training, the Oregon Model (PMTO(®)). Following a description of our international partnership, we describe the implementation of the pilot study aimed at determining initial feasibility. Qualitative data provided by 40 Mexican mothers exposed to the culturally adapted parenting intervention illustrate the participants' high level of receptivity toward the intervention, as well as the beneficial impact on their parenting practices., (© 2014 American Association for Marriage and Family Therapy.)

Ongoing racial/ethnic health disparities place increasing emphasis on the importance of interpreters in mental health treatment. Yet there is a limited body of research examining how interpreters and clinicians work together in delivering care. This article used an ethno-culturally informed qualitative procedure to ask interpreters and clinicians about their experiences in cross-language mental health treatment. Seventeen semistructured interviews were conducted with 10 interpreters and 7 clinicians. The interplay of power was experienced differently by interpreters and clinicians as exemplified by 3 categories of meaning: Interpreters speaking out, The relationship matters, and Who has the power? The authors recommend future research focus on the clinician-interpreter relationship as an essential piece of cross-cultural mental health delivery., ((c) 2015 APA, all rights reserved).)

This article reports the results of a feasibility study of an intervention, Enhancing Family Connection (EFC), conducted in Northern Uganda in 2012. Enhancing Family Connection's sessions were an adaption of the Parent Management Training, Oregon model. Three interrelated areas of feasibility were assessed: (a) acceptability, (b) usability, and (c) limited efficacy. This study utilized questionnaires and semi-structured interviews completed by mothers and a focal child pre- and post-intervention. Results indicated that mothers found the intervention acceptable to their families and culture and showed promise for Enhancing Family Connection's efficacy in changing parenting behaviors. This study supports continued development of this intervention.

We explored the mental health effects of war trauma and torture as described by 111 refugees newly arrived in the United States. We used ethnocultural methodologies to inform 13 culture-specific focus groups with refugees from Bhutan (34), Burma (23), Ethiopia (27), and Somalia (27). Contrary to the belief that stigma prevents refugees from discussing mental health distress, participants readily described complex conceptualizations of degrees of mental health distress informed by political context, observation of symptoms, cultural idioms, and functional impairment. Recommendations for health care providers include assessment processes that inquire about symptoms in their political context, the degree of distress as it is culturally conceptualized, and its effect on functioning. Findings confirm the cross-cultural recognition of symptoms associated with posttraumatic stress disorder; however, refugees described significant cultural variation in expressions of distress, indicating the need for more research on culture-bound disorders and idioms of distress., (© The Author(s) 2014.)

Narrative therapy is a postmodern, collaborative therapy approach based on the elaboration of personal narratives for lived experiences. Many aspects of narrative therapy suggest it may have great potential for helping people who are negatively affected by traumatic experiences, including those diagnosed with posttraumatic stress disorder (PTSD). The potential notwithstanding, narrative therapy is relatively untested in any population, and has yet to receive empirical support for treatment among survivors of trauma. A pilot investigation of the use of narrative therapy with 14 veterans with a diagnosis of PTSD (11 treatment completers) is described. Participants completed structured diagnostic interviews and self-report assessments of symptoms prior to and following 11 to 12 sessions of narrative therapy. After treatment, 3 of 11 treatment completers no longer met criteria for PTSD and 7 of 11 had clinically significant decreases in PTSD symptoms as measured by the Clinician Administered PTSD Scale. Pre- to posttreatment effect sizes on outcomes ranged from 0.57 to 0.88. These preliminary results, in conjunction with low rates of treatment dropout (21.4%) and a high level of reported satisfaction with the treatment, suggest that further study of narrative therapy is warranted as a potential alternative to existing treatments for PTSD., (Published 2014. This article is a US Government work and is in the public domain in the USA.)

This study was undertaken in an effort to help illuminate the deleterious effects of traumatic stress on children and families in Mexico. Rates of exposure to traumatic events, family and community violence, and posttraumatic stress disorder (PTSD) were investigated in 87 school-age children and their mothers. Binary logistic regression analysis was performed to examine potential family and ecological risk factors for the presence of child PTSD. A total of 51 children (58.6%) reported an event that met the DSM-IV A criteria, and 36 children (41.4%; 20 boys and 16 girls) met criteria for full PTSD. Traumatic exposure in this sample was considerable, particularly intense, and chronic as a result of interpersonal violence in the home and community. Results support the need for preventive systemic interventions targeting the individual level, parent-child dyadic level, and the larger cultural and community context., (Published by Elsevier Ltd.)

Substance abuse continues to be a family problem in American Indian (AI) families. This article highlights findings from a two generation study on substance abuse among nine AI families. Five common themes shared by the parent and adult child groups included early onset of substance abuse, minimization of substance abuse (and a subtheme of efforts to control use), taking accountability for substance abuse (and a subtheme about perpetuated stereotypes), turning point moments in use (and a subtheme of negotiating and exploring sobriety), and perceptions of the abstinence only approach. Clinical implications are discussed in light of the findings.

This study examines the impact of children's exposure to natural disaster against the backdrop of exposure to other traumatic events and psychosocial risks. One thousand three hundred ninety-eight Sri Lankan children aged 9-15 years were interviewed in 4 cross-sectional studies about exposure to traumatic life events related to the war, the tsunami experience, and family violence. Symptoms of posttraumatic stress disorder, somatic complaints, psychosocial functioning, and teacher reports of school grades served as outcome measures. A global outcome variable of "positive adaptation" was created from a combination of these measures. Data showed extensive exposure to adversity and traumatic events among children in Sri Lanka. Findings of regression analyses indicated that all 3 event types--tsunami and disaster, war, and family violence--significantly contributed to poorer child adaptation.

As the Latino population in the United States continues to increase, so does the necessity for in-depth knowledge about their life experiences. This qualitative study sought to privilege the voices of Latino parents by utilizing focus group discussions. Specifically, participants described the life experiences that have the greatest influence on their parenting efforts. Similar and contrasting themes were identified based on participant country of origin (i.e., foreign born vs. U.S. born). Findings described the participants' commitment to being good parents, as well as the ways in which their parenting efforts are influenced by experiences of adversity and discrimination, Latino cultural values, gender roles, and resilience. The results of this investigation can inform researchers and mental health professionals working with Latino families.

Vulvar vestibulitis syndrome (VVS), a vulvar pain disorder, continues to puzzle medical and mental health professionals due to its unknown etiology and lack of effective treatment. This study used transcendental phenomenology methodology to explore the experiences of couples in which the woman has a diagnosis of VVS. Sixteen in-depth semi-structured interviews were conducted with 13 heterosexual couples and 3 women. Four essences emerged: (1) In search of ... the medical journey required extensive searching for knowledgeable and respectful practitioners to provide treatment. (2) The process of developing a personal understanding of this disorder led many couples to question their role in causing and maintaining VVS. (3) Developing strategies for coping with painful intercourse led to three strategies: becoming non-sexual, using alternatives to vaginal sex, and altering or enduring painful intercourse. (4) Feelings of isolation were experienced as adapting to this chronic pain syndrome was often a lonely process. Clinical suggestions included: treating the couple, not just the woman with VVS; encouraging couples to broaden definitions about the importance and primacy of vaginal intercourse and suggest alternative sexual activities less likely to cause vulvar pain; developing shared meaning as a couple, and assisting couples in locating physicians and resources. Suggestions are relevant for couples with VVS and those with chronic health problems affecting sexual relationships.

This article presents an overview of the philosophy and practical principles underlying the Linking Human Systems Approach based on the theory of resilience in individuals, families, and communities facing crisis, trauma, and disaster. The Link Approach focuses on tapping into the inherent strength of individuals and their families and emphasizes resilience rather than vulnerability. It has been successfully used in combating critical public health problems, such as addiction, HIV/AIDS, and recovery from major trauma or disaster. Also, three specific models of Link intervention aimed at the individual, family, and community levels are discussed, with special emphasis on the family-level intervention. These interventions are directed toward mobilizing resources for long-term physical, emotional, psychological, and spiritual healing.

Trauma research has identified a link between parental adjustment and children's functioning and the sometimes ensuing intergenerational impact of traumatic events. The effects of traumatic events on children have been demonstrated to be mediated through their impact on children's parents. However, until now, little consideration has been given to the separate and more proximal mechanism of parenting practices as potential mediators between children's adjustment and traumatic events. To shed some light in this arena, we review literature on trauma, adversity, and resilience, and discuss how parenting practices may mediate trauma and adverse environmental contexts. Using a social interaction learning perspective (Forgatch & Knutson, 2002; Patterson, 2005), we propose a prevention research framework to examine the role that parenting practices may play in influencing children's adjustment in the wake of trauma exposure. The article concludes by providing a specific model and role for evidence-based parenting interventions for children exposed to mass trauma.

Recognizing mental health needs of diverse populations, emphasizing cultural diversity, and recruiting ethnic minority students are important foci of current of marriage and family therapy training programs. However, the profession has made little progress in identifying the needs and experiences of its international students and practitioners. This research examines the experiences of doctoral-level international students across the areas of theory, clinical training, supervision, practice, and research. A qualitative methodological approach was used to explore the research questions. Thirteen in-depth interviews were conducted. Findings revealed that most respondents experienced some adjustment problems, want more academic and career support, and need increased recognition for their cultural differences. Recommendations for training international students are included.

Self-reflection, typically operationalized in scales of egocentrism and introspectiveness, is portrayed as problematic in much of the literature on adolescents. Self-reflection has been linked to dysfunctional self-consciousness, symptomatology, and risk behaviors. Yet, self-reflection also is seen as essential for adolescent development, particularly with respect to individuation and identity. In this exploratory study, the authors focused on the process of self-reflecting. From interviews with 10 students conducted over the first 2 university years, the authors longitudinally assessed and then evaluated self-reflecting patterns in relationship to a narrative analysis of developmental change. Students who showed evidence of developmental change or sustained engagement in developmental work over the study period devoted a higher percentage of their interview conversation to self-reflecting content. Differences in self-reflecting patterning over time among the students who showed developmental change further suggest linkages between self-reflecting and development. The authors discuss implications for the conceptualization of self-reflecting in relationship to development and for the reinterpretation of previous studies.

Recently, some family scholars have developed greater sensitivity to the relative neglect of families of color in clinical and empirical research. Consequently, a proliferation of research elucidating many nuances of ethnic families has come to the forefront, containing a wealth of knowledge with useful implications for family therapists and other mental health providers. The findings of these studies hold enormously important implications for how family therapists can better engage and accommodate families of color in therapy. In this article we discuss some of the etiological and methodological issues associated with planning, conducting, and disseminating family-based prevention and intervention research programs with ethnic minority families.

A team of therapists from Minnesota and New York worked with labor union families of workers gone missing on September 11, 2001, after the attack on the World Trade Center, where they were employed. The clinical team shares what they did, what was learned, the questions raised, and preliminary evaluations about the multiple family meetings that were the major intervention. Because of the vast diversity, training of therapists and interventions for families aimed for cultural competence. The community-based approach, preferred by union families, plus family therapy using the lens of ambiguous loss are proposed as necessary additions to disaster work.

The paucity of literature addressing mental health issues concerning geriatric populations represents the perpetuation of ageist practices and beliefs in the field of marriage and family therapy. The purpose of this study was to assess whether client age and clinical training relate to the evaluation of couples who present for conjoint therapy. Written vignettes describing two couples, one older and one younger, who report issues involving the absence of sexual intimacy, increased frequency of arguments, and increased use of alcohol were evaluated by practicing marriage and family therapists, therapists-in-training, and individuals with no clinical background. It was hypothesized that respondents' views would vary in connection with the age of the couple and with the three levels of participant training. Results indicate that client age and participant training are associated with perceptions of individual and couple functioning. Our findings suggest that the relational and mental health concerns experienced by elder couples are not perceived as seriously as are identical concerns experienced by younger couples. Contrary to our expectations the observed differences between views of the two age conditions did not significantly differ between levels of participant training. Training and experience in marriage and family therapy may not significantly mitigate vulnerability to age-discrepant views.