MENTAL HEALTH RESEARCH: News You Can Use! Vol I

With funding from LACDMH, in collaboration with the USC School of Social Work and the Pacific Clinics Training Institute, 40 new Health Navigators received 24 hours of training on three Fridays in March. Participates were community workers, case managers, peer advocates, community services coordinators and medical case workers from 19 DMH directly operated and 16 contract agencies. Follow-up activities are being conducted to support implementation of the Health Navigator program into this wide variety of settings (including crisis resolution centers, FSPs and wellness centers) with various consumer populations (children, TAY, adults and older adults) from all eight Service Areas in LA County. These include 1:1 and group supervision sessions for the new Health Navigators as they begin to help navigate consumers through the health care system, Webinars to assist supervisors with problem solving issues as they arise, and ongoing evaluations of the program's success. Watch for announcements of future trainings. For questions about the project please contact the Bridge Team.

CHILDREN'S RESEARCH

Marleen Wong, PhD

Clinical Professor

Assistant Dean of Field Education

USC School of Social Work

In Honor of National Children's Mental Health Awareness Day, May 9, 2012, this issue of MENTAL HEALTH RESEARCH: News You Can Use! will focus on one of Community Engagement's Advisory Board Members, Marleen Wong, PhD. Recognized by the White House as one of the "pre-eminent experts in school crisis and recovery" and the "architect of school-safety programs" by the Wall Street Journal, Dr. Wong has developed mental health recovery programs, crisis and disaster training for school districts and law enforcement in the United States, Canada, Israel and Asia for the past 30 years.

Frequently consulted by the U.S. Department of Education to assist schools impacted by violence, shootings, terrorism and natural disasters, she has lent her expertise to the recovery from a range of major crises, from the September 11, 2001, terrorist attacks and the Columbine school shootings to the 1992 civil unrest in Los Angeles and the sniper shootings in Washington, D.C. Internationally, she has advised teacher unions and school and government officials on the effects of psychological trauma on schoolchildren and adults after devastating earthquakes in Kobe, Japan, and the Sichuan Province in China.

Formerly the director of crisis counseling and intervention services for the Los Angeles Unified School District (LAUSD), Wong is one of the original developers of the Cognitive Behavioral Intervention for Trauma in Schools (CBITS), an evidence-based program using skill-based group intervention to relieve symptoms of post-traumatic stress disorder, depression and general anxiety among children traumatized by violence, bullying and trauma.

What is Cognitive Behavioral Intervention for Trauma in Schools (CBITS)?

CBITS is a skills-based, group intervention that is aimed at relieving symptoms of Post-Traumatic Stress Disorder (PTSD), depression, and general anxiety among children exposed to trauma. Children learn skills in relaxation, challenging upsetting thoughts, and social problem solving, and children work on processing traumatic memories and grief. These skills are learned through the use of drawings and through talking in both individual and group settings. Between sessions, children complete assignments and participate in activities that reinforce the skills they've learned. CBITS also includes parent and teacher education sessions.

To develop this program Dr. Wong, in collaboration with her colleagues at UCLA, LAUSD and RAND, conducted the first randomized controlled study of a program to help children traumatized by violence. The team developed and implemented an earlier program designed specifically for immigrant children, many of whom are subjected to violence in their country of origin, during their immigration to the United States, and/or after their arrival (often to a disadvantaged neighborhood). Building on the earlier work, the team designed and conducted a randomized controlled study in the 2000-2001 academic year. Students in the study attended one of two Los Angeles public middle schools in largely Latino neighborhoods. Psychiatric social workers from LAUSD administered a screening questionnaire to English-speaking sixth-grade students in the two schools. Students were eligible to participate in the program if they (1) had substantial direct exposure to violence, (2) had post-traumatic stress symptoms in the clinical range (a score of 14 or higher on the CPSS, the Child Post-Traumatic Stress Symptom Scale), and (3) were willing to discuss their symptoms in a group setting. Participants' experience with violence ranged from witnessing serious physical fights to being attacked with a knife or gun. A total of 159 students were eligible to participate; 126 actually participated (the parents of 28 children did not give consent and five children elected not to participate). All 126 students completed the baseline assessments; 93 percent completed a three-month follow-up; and 90 percent completed both the three-month and the six-month follow-ups. Students were randomly assigned to two groups. One group (the early-intervention group) started the program promptly; the other (the late-intervention group) was waitlisted for later in the school year.

The intervention program consists of 10 group sessions designed for inner-city schools with a multicultural population. Activities include training children in relaxation, dealing with negative thoughts, solving real-life problems, approaching anxiety-provoking situations, and coping with the violent event through talking, drawing pictures, and writing. The program is also designed to build both peer and parental support. In addition to the group sessions, the program included at least one individual session for each child, four group parenting meetings, and an educational presentation for teachers. The LAUSD school clinicians who delivered the program received two days of training and weekly supervision from the other members of the research team. To help ensure that the program was standardized, the clinicians followed the CBITS treatment manual.

What were the results from the research study?

Students who participated in the program had significantly less post-traumatic stress symptoms, less depression, and less psychosocial dysfunction. The program was implemented successfully by school-based mental health clinicians. The participating schools, located in economically disadvantaged neighborhoods, have a large percentage of Latino students, demonstrating the program's ability to reach poor and minority children. And the program was welcomed by students, teachers, school officials, and parents. More details about the study, including charts of the results, are included in the RAND Highlights article.

Where can I find more information about CBITS?

For more information you can contact Dr. Wong or her colleague Audra Langley, Ph.D. at the UCLA Semel Institue for Neuroscience and Human Behavior, Trauma Services Adaptation Center for Resiliency Hope and Wellness in Schools.. The CBITS manual, with session-by-session descriptions of activities for each session, is available at Sopris West.

CBITS is now a recognized program by the National child Traumatic Stress Network. For more trauma focused resources go to their website.

For more recent research and summaries from RAND visit their website.

Submitted by Holly Kiger, RN, MN, CNS, Research Navigator, SC CTSI, Community Engagement