Strengths and Challenges in Community Integrated Intervention for Urban Youth Exposed to Environmental Adversities and Trauma

Background: Adversities in childhood pose significant threats to youths’ developmental foundation needed for the achievement of their full health and social and economic potential (Metzler et al. 2017; Shonkoff, 2012). Within families, the negative effects of various adversities, including traumas, can be transmitted intergenerationally, linked by cumulative experiences of insensitive parent-child interactions, ineffectual parenting, and environmental disparities in health and economic resources (Voncina et al., 2017; Widom & Wilson, 2015). Untreated traumas lead to negative long-term health and mental health outcomes, particularly for youth and families of color (Finkelhor, 2015; Hughes et al., 2017). Close to 50% of youths living in the nation’s capital have been exposed to multiple traumas, such as experiencing parental incarceration or death, witnessing or being victims of violence, or living with suicidal, drug-addicted, maltreating family members (National Survey of Children's Health, 2016). To reduce and mitigate youth exposure to environmental adversity and trauma in an integrated, community wrap-around approach (Myers et al., 2015), a non-profit mental health agency has partnered with multiple community organizations and schools to implement a home-based, family intervention to deepen support for social-emotional and behavioral needs of urban youths (aged 6-17 years) receiving school-based mental health services. The intervention uses the evidence-based Trauma Adapted Family Connections model (Collins et al., 2015) to reduce behavioral difficulties and to increase psychosocial and relational strengths of urban youth and families. Pearlin’s (1981, 2005) theoretical stress model for reducing cumulative, racially-patterned social disadvantages across the life course (Braveman & Barclay, 2009) justifies the application of the home-based, community integrated intervention designed for African American and Latino youth and families. The current study investigates whether youths participating in the home-based family intervention improve their behavioral and social-emotional outcomes from before to after the six months of intervention. The 5-year project is federally funded by SAMHSA through the NCTSN. The Institutional Review Board of the university-partner approved the study.

Methods: The study uses a quantitative repeated measures design with bivariate and multivariate analytics. Youth outcomes examine changes in symptoms of post-traumatic stress disorder (PTSD), depression, strengths and difficulties in behavior, and parental communication with youth. Presentation describes the study intervention, enrollment-protocol, sample characteristics, data collection procedures, and the reliability of standardized outcome measures.

Results: Seventy-one youths and their families completed a full-dose of the home-based intervention by the spring of 2020. Findings reveal that on average, parental-caregivers were exposed to a substantial amount of adversity and trauma (even before the Covid-19 pandemic), having direct experiences with ten or more stressful life events (PCL-5, criterion A). Youth beneficial effects and significant (p<0.05) changes were seen in reduced PTSD symptoms (CPSS/STRESS), reduced behavioral conduct and attentional problems and improved relationships (SDQ), and better parental-communication with youth (PACS/NPACS). Additional discussion includes implications for therapeutic practice, current study limitations, and recommendations for future research.

Conclusions: Providing a community integrated, social work oriented, home-based therapeutic mental health support to urban youth and their families can mitigate the negative impact of trauma on youths living in environmentally adverse conditions.