Background: Adversities related to trauma exposure in childhood pose significant threats to youths’ developmental foundation needed for the achievement of their full health and social and economic potential (Bellis et al., 2019; Metzler et al. 2017). Trauma exposure is an established risk factor for youth behavioral difficulties and justice involvement (Mendez et al., 2022). Within families, trauma can be transmitted intergenerationally, (Voncina et al., 2017; Keels, 2022). Untreated traumas lead to negative long-term health and mental health outcomes, particularly for youth and families of color (Metzger et al., 2021; Thomas et al., 2019). Close to 50% of youths living in the nation’s capital have been exposed to multiple traumas, including experiencing parental incarceration or death, witnessing or being victims of violence, and living with suicidal, drug-addicted, maltreating family members (National Survey of Children's Health, 2016-2019). To mitigate youth exposure to environmental trauma with a community wrap-around approach (Myers et al., 2015), a non-profit mental health agency has partnered with multiple community organizations including schools during 2016-2021, and implemented both school-based and home-based interventions, to deepen support for social-emotional and behavioral needs of urban, African-American and Latino youths (aged 6-17 years) receiving school-based mental health services. The school-based intervention uses adapted Trauma-focused-Cognitive-behavior-therapy (TF-CBT), while the home-based intervention adds the Trauma-adapted-Family-connections (TA-FC) model (Collins et al., 2015). Pearlin’s (1981, 2005) theoretical stress model for reducing cumulative, racially-patterned social disadvantages across the life course (Braveman & Barclay, 2009), justifies the applications of both school-based and home-based, community integrated interventions. The current study investigates a multivariate research question, whether there is a significant difference between youths participating in a home-based intervention, when compared to matched counterparts in school-based intervention, on two youth outcomes, while controlling for various factors. The study was part of federally funded project by SAMHSA with NCTSN. Participating parents provided informed consent and youths assented prior to study initiation. The Institutional Review Board of the university-evaluation-partner approved the study.
Methods: The study applies short-longitudinal design with multivariate repeated measures of mixed RANOVA analytics with a matched sample of 142 youths, who completed their respective interventions during 2018-2019. The youths were matched on format of TF-CBT during school portion of interventions and age, gender, race/ethnicity, and grade. Youth outcomes examine changes on symptoms of post-traumatic-stress disorder and depression, measured with STRESS and MFQ, respectively. Presentation describes both interventions, enrollment-protocols, matching-process, sample-characteristics, data collection, validity/reliability of outcomes, and testing, along with study limitations, and future research.
Results: The sample consisted of 26 Home-based youths and 116 matched School-based youths. Both compared youths benefited by their respective interventions, but Home-based youths, had statistically significantly better reduction in the mean level of symptoms on both STRESS and MFQ outcomes over their intervention, and with moderate to large effects, when compared to their matched counterparts. Practice implications are further discussed.
Conclusions: Although providing a school-based intervention confers benefits, providing a community integrated, home-based therapeutic mental health support to urban youth and their families better mitigates the negative impact of trauma on youths.
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