CURRENT TRUST LAB RESEARCH
(Updated: February 2024)
SHARK Study: Primary Care intervention for PTSD in Youth and Adolescents Randomized Controlled Trials
This study uses rapid innovation to evaluate the feasibility and effectiveness of implementing a protocol for PTSD in adolescent primary care in LAC DHS clinics and other clinics that provide care to diverse youth with complex psychosocial, physical, and mental health needs. The mixed methods randomized feasibility trial of the protocol will be measured by the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). We will collect data on patient and clinic staff participation, retention, and satisfaction (Reach and Adoption), change in hypothesized treatment mechanisms and symptoms (Effectiveness), and facilitators and barriers to intervention delivery and fidelity (Implementation).
Research questions: (1) whether the Primary Care Intervention for PTSD (PCIP) improves health outcomes; (2) whether and how the PCIP can be sustainably delivered via telehealth; and (3) how PCIP compares to trauma focused cognitive behavioral therapy and treatment as usual participants?
Specific Aims
- Assess the reach and adoption of the protocol by analyzing quantitative data on patient and clinic staff participation, retention, and satisfaction;
- Explore the effectiveness of the protocol through medical record review, quantitative assessments at baseline and post-treatment, and semi-structured qualitative interviews at baseline and post-treatment to:
- Evaluate the implementation of the screening and intervention protocol with post-intervention semi-structured qualitative interviews to assess facilitators and barriers to intervention delivery, quantitative fidelity scales, observation of screening, and review of intervention audio recordings to assess fidelity to the protocol and intervention process.
PTSD Treatment in Primary Care Clinics in Rural Ethiopia: Feasibility and Implementation Trial
This study is a mixed methods pilot trial to assess the feasibility, implementation, and effectiveness of the Brief Relaxation, Education and Trauma Healing (BREATHE) Ethiopia intervention. This study will also assess the validity and usability of the adapted intervention and materials for primary care in rural Ethiopia. This data will be used to estimate effect sizes for a future fully powered trial.
Specific Aims
- Test adapted BREATHE Ethiopia measures and manual materials and physiological assessment tools
- Cognitive testing of these tools with patients with SMI in Sodo district to ensure that the measures are well understood
- Conduct usability tests of intervention worksheets, handouts, and measures of physiological arousal including measures of heart rate and skin conductance to ensure that they are acceptable to patients and usable in the field.
- Conduct usability testing of the manual with primary care providers to ensure that the manual and materials are understandable, attractive, and usable.
- Conduct a mixed methods non-randomized pre-pilot and randomized pilot feasibility trial to explore intervention effectiveness.
- Change in hypothesized treatment mechanisms: (1) increased knowledge about PTSD; reductions in (2) PTSD-related stigma; (3) trauma-related cognitions; and (4) self-reported arousal; (5) increased use of stress management strategies; and (6) reductions in physiological arousal as measured by increased heart rate variability.
- Change in symptoms and functional impairment. Reductions in (1) PTSD (2) depression and anxiety symptoms, and (3) functional impairment.
- Conduct a mixed methods process evaluation to assess intervention implementation to refine the intervention.
- Mixed methods multi-stakeholder process evaluation of the fidelity to and implementation of the intervention as measured by the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance)
Project Lead: Gray Bowers
Cognitive Consequences of an Initial Traumatic Event and Its Impact on Future Trauma Exposure
The proposed study will examine how the cognitive sequelae of an initial traumatic event may increase vulnerability for future trauma exposure. This secondary analysis of longitudinal data includes information on demographics, trauma exposure, posttraumatic stress symptoms, and cognitive assessments, including attention, learning, reaction time, working memory, and psychomotor speed.
Specific Aims
- Examine the impact of trauma on processing speed and executive functioning, such as attention and working memory, in order to identify whether deficiencies in these cognitive abilities (after an initial trauma exposure) increase risk for future trauma exposure.
- Investigate whether trauma type influences the risk for cognitive deficiencies and subsequent retraumatization.
Graduate Student Lead: Rddhi Moodliar
Factors Moderating PTSD Treatment Effectiveness in Sexual Minority Asylum Seekers
This project is investigating factors that moderate mental health outcomes of asylum seekers in the US across two studies. The first study, is using quantitative and qualitative data from intake assessments and narrative interviews with persecuted asylum seekers who sought services at Boston Medical Center. The second study uses qualitative narratives obtained from Boston Medical Center clinicians who have provided treatment to both LGBT and non-LGBT asylum seekers to analyze and determine differences in treatment outcomes for sexual minority asylum seekers. The purpose of the research is to examine the relationship between mental health outcomes and social determinants of asylum seekers who have faced persecution (e.g. “sexual preference”, “political”, “religious”, other”). Using quantitative and qualitative data, this study seeks to understand factors that may differentiate between torture survivors based on their reasons for persecution.
Specific Aims
- Analyze existing client data using the social determinants of health framework and compare results with those of clients who are seeking asylum for reasons of persecution.
- Compare LGBT asylum seekers to a subset of clients who were persecuted for their support of the LGBT community
- Understand possible moderators and mediators of these potential discrepancies in mental health outcomes, particularly regarding the identity of the perpetrator, specifically the closeness of the relationship between the perpetrator and the victim, as well as levels of rejection and support received by the victim.
- inform services and provide insight into the ways that multiple identities and experiences impact trauma treatments and outcomes.
Graduate Student Lead: Christine Bird
Developing a PTSD Intervention for Legal System Involved Youth in collaboration with Community Partner Organizations
This mixed methods study sought to leverage stakeholder perspectives to better understand programmatic goals, and elucidate underlying intervention mechanisms, and build a working model of Healing Dialogue and Action’s (HDA) youth services to increase intervention feasibility, scalability, and effectiveness. Ultimately,this study plans to develop a brief intervention that can be delivered by legal system staff for prevention/treatment of PTSD in youth. Formative qualitative research has been conducted examining legal system key stakeholders (N=11) perspectives regarding current treatment and assessment for PTSD in youth legal system, barriers and facilitators to care, and experiences with mental health interventions targeting trauma.
Specific Aims
- Train HDA staff in research methods and to work with them to develop a Theory of Change map for their curriculum to identify mechanisms of change and to identify mixed-methods strategies to evaluate change in mechanisms and the effectiveness of their program over time.
- Work with HDA to incorporate trauma informed evidence based practices into existing curriculum in order to strengthen their intervention and prevention programming for youth targeting trauma.
- Pilot the adapted HDA curriculum and to collect mixed-methods data from HDA staff and youth in the Los Angeles County camps to assess the acceptability and feasibility of the adapted approach using a Community Based Participatory Research lens.
Project Lead: Gray Bowers
Feasibility of Utilizing Direct-to-Consumer (DTC) Strategies to Increase Engagement
This feasibility study uses quantitative data and qualitative data to identify characteristics of psychological service websites that may be acceptable and engaging to diverse youth.
Specific Aims
- Examine how direct-to-consumer strategies can be used to improve mental health service engagement among young people.
- Identify characteristics that can make psychological service websites engaging for young people.
Graduate Student Lead: Yesenia Aguilar Silvan
Health Service Disparities Among Youth Who Have Experienced Sexual Violence: The Role of Intersectional Identities
This study seeks to identify interactions between various demographic characteristics and identify intersectional identities among patients with UCLA Health medical record data (e.g. Ronald Reagan hospital, Santa Monica hospital, UCLA Health clinics).
Specific Aims
- Identify rates and types of maltreatment that are reported to health care providers pre and post California ACEs mandate.
- Identify rates of maltreatment health service referrals pre and post California ACEs mandate.
- Examine maltreatment identification rates and health service referral rates disparities by youths’ intersecting minority identities (i.e., age, gender identity, sex, race/ethnicity, education, country of origin, and socio-economic status
Graduate Student Lead: Yesenia Aguilar Silvan
Increasing the Demand for and Engagement in Evidence-Based Treatments: Implementing Direct-To-Consumer Strategies for Youth of Color and Immigrant Youth
The purpose of this research is to use an experimental design to test direct-to-consumer strategies (i.e. website launch) to improve mental health service engagement for client. In particular, this study aims to increase service engagement among trauma exposed youth of color and immigrant youth.
Specific Aims
- Test whether changes to the website increase consumer engagement with the website and subsequent self-referral to the clinic.
- Assess whether changes in consumer behavior differ by demographic status and clinical presentation, such that changes to the website made to attract trauma exposed youth of color and immigrant youth would result in a greater change in clinic engagement than for adults, non-Latino white clients, and clients with non-trauma related clinical presentations.
Graduate Student Lead: Yesenia Aguilar Silvan
Patient Engagement Child Psychiatry Services
The purpose of this study is to identify the points in treatment where child and adolescent patients are the most vulnerable to dropping out of psychiatric care, as well as factors that may contribute to this vulnerability. This information will help us target areas for further research and specific patient, provider, and organizational level interventions aimed at improving dropout rates.
Specific Aims
- Identify treatment dropout, retention rates, and when dropout is most likely to occur in psychiatric services.
- Assess the associations between dropout/retention, patient characteristics, treatment provider, and treatment provided.
Graduate Student Lead: Yesenia Aguilar Silvan
PTSD in Adolescent Medicine Qualitative Study: Minority Identity in a Short-Term Treatment
A qualitative and quantitative data analysis of audio-recorded PTSD-related therapy sessions therapy sessions and subsequent qualitative interviews to examine the role of minority identity status within a brief-PTSD treatment. This study is a secondary data analysis of a broader study assessing utilization, acceptability, and effectiveness of a brief PTSD treatment. Taped PTSD therapy sessions, qualitative interviews, and medical charts are being analyzed to identify themes related to the participants’ identities and examine whether these themes are related to treatment outcome or engagement.
Specific Research Questions:
- Did participants bring up their minority identity status in treatment? Is so, in what contexts?
- How did clinicians respond to participants’ identity or contextual-related concerns within treatment?
- Did this impact the course of treatment (i.e. treatment satisfaction & symptom change)?
Graduate Student Lead: Gia Chodzen
Trauma Services Implementation for People Experiencing Homelessness: Community asset mapping and CBPR best practices
This study aims to improve the implementation of trauma interventions for people experiencing homelessness. In particular, this study will focus on trauma intervention delivery in community settings. Additionally, this project aims to identify best practices for conducting community-based participatory research (CBPR) with this population.
Specific Aims
- Outline a step-by-step process on partnering with a community-based organization, informed by CBPR experts.
- Identify both currently available and gaps in trauma interventions in community settings for individuals experiencing homelessness.
- Understand homelessness service organizations’ needs and perspectives in regard to implementing trauma interventions in community settings for this population.
Graduate Student Lead: Rddhi Moodliar
EMA Feasibility: A Pilot Study of Recruitment for a Study of Relationship Conflict in Daily Life Using Ecological Momentary Assessment
This study aims to collect quantitative and qualitative data to better understand recruitment patterns and overall feasibility for a study of relationship conflict in daily life with underserved and underrepresented communities.
Specific Aims:
- To test if there are sociodemographic differences, specifically in race and ethnicity, of interested, eligible study participants and those who subsequently enroll in the EMA portion of the study.
- Assess the feasibility of enrolling participants’ partners into the study if the initial participant consents to their partner being contacted.
- Test if relationship conflict and racial/ethnic minority status predict enrollment willingness and adherence to the EMA protocol portion of the study.
- Understand participants’ motivations for enrolling in a study on relationship conflict in daily life using qualitative data collected at baseline and endpoint.
Graduate Student Lead: Megha Nagaswami
PTSD Screening and Treatment in Adolescent Medicine Primary Care
This projects consists of two studies assessing the utilization, acceptability, and effectiveness of a brief PTSD treatment, and the validity of a brief screener for PTSD with an urban sample of adolescents aged 12-21. The feasibility trial is a mixed methods pre-test of the implementation and effectiveness of a 3-session treatment for PTSD delivered in Adolescent Medicine primary care.
Specific Aims
- Assess the reach and adoption of the protocol by analyzing quantitative data on patient and clinic staff participation, retention, and satisfaction;
- Explore the effectiveness of the protocol through quantitative assessments at baseline and post-treatment, and semi-structured qualitative interviews at post-treatment to:
- Assess change in hypothesized treatment mechanisms including (1) increased knowledge about PTSD; reductions in (2) PTSD-related stigma; (3) trauma-related cognitions; and (4) self-reported arousal; and (5) increased use of stress management strategies; and change in symptoms and functional impairment including reductions in (1) PTSD, (2) depression and anxiety symptoms, and (3) functional impairment;
- Evaluate the implementation of the intervention with post-intervention semi-structured qualitative interviews to assess facilitators and barriers to intervention delivery, and quantitative fidelity scales, observation of screening, and review of intervention audio recordings to assess clinic staff fidelity to the protocol.
- Assess the validity, specificity and sensitivity of a 5-item yes/no screener of PTSD symptoms in patients attending the Adolescent Medicine clinic.
- Examine how well the brief screener is able to identify participants with PTSD in comparison to the TESI-C and CPSS.
Healing and Resilience after Trauma (HaRT) Yoga: a mixed-methods secondary analysis
The proposed study is a secondary analysis of data from a program evaluation of the Healing and Resilience after Trauma (HaRT) program in Kampala, Uganda. HaRT is a trauma-informed yoga intervention that was administered to trafficking survivors residing in a women’s shelter in Kampala. Primary data collection occurred from February to October 2020. The intervention lasted 12 weeks, during which yoga classes were conducted weekly, either live or through pre-recorded videos. Data was collected at baseline, midpoint, endpoint, and at a 1-month follow up.
Specific Aim: To understand changes in HaRT participants’ perceived social support and compassion over the course of the intervention in comparison to the control group. We also plan to utilize the qualitative data to attempt to understand the specific ways in which the yoga intervention facilitated changes in both social support and compassion. We will examine the qualitative data to identify any themes or patterns that explain specific mechanisms contributing to changes in these two variables.
Graduate Student Lead: Megha Nagaswami
Investigating The Effect of Experiences in Detention on Recidivism for Impulsive Youth
The proposed study involves secondary analysis of longitudinal observation data from the Pathways to Desistance dataset. This dataset tracked youth who were convicted of an offense as a juvenile. We are interested in understanding how youth with higher levels of impulsivity experience detention differently than youth with low levels of impulsivity and in turn, how those experiences predict recidivism. Understanding the experiences of youth in detention who struggle with impulsivity and how it relates to recidivism can provide important information for developing interventions designed to improve outcomes for these youth in detention.
Specific Aim: Determine whether adverse experiences in detention/jail serves as a mediator through which impulsivity leads to higher recidivism rates. We predict that because a highly structured environment, such as detention, is unlikely to meet the unique needs of youth who struggle with impulsivity, these youth will have more frequent adverse experiences in detention (i.e., get in trouble more frequently and have poorer relationships with staff), which in turn, will be associated with higher rates of recidivism.
Project Lead: Makena Tinney & Gray Bowers
Current Systematic Reviews
- Capitalizing on Marketing Strategies to address disparities in Mental Health service engagement: A Systematic Review
- Emotional Abuse and Neglect: A Systematic Review
- Intersectional Minority Identity and PTSD: A Systematic Review
Recent Undergraduate RA Posters
- Meaning-Making and Mental Health Outcomes in the Divorced Family System
- Effects of COVID-19 on Human Trafficking Survivors Social Withdrawal Symptoms in a Shelter in Kampala, Uganda
- Association between Fear for Family and PTSD and Depression Symptoms in Refugee and Asylum Seekers
- Impacts of Perimigration and Post-Migration Stressors on Asylum Seekers’ Mental Health Outcomes
- The Differences in Torture Between Female and Male Asylum Seekers in the United States
- The Effects of the Client-Therapist Relationship on Treatment Outcomes for Juvenile Offenders