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Latino youth represent more than one quarter of the overall public school population in the United States. For decades, Latinos have been found to perform significantly lower than their peers in standardized academic and some social and emotional measures. A unique subpopulation of this ethnic group, Latino Youth of Immigration (LYOI), has historically been underrepresented in the research literature, specifically, attempting to identify effective interventions that align with their unique social, emotional, and academic needs. In this chapter, we describe the unique sociocultural risk and protective factors for this population. In addition, we provide a brief synthesis of the extant literature on the sociocultural factors that researchers and practitioners need to address in partnership with the LYOI community when developing and implementing preventative programs. We emphasize the unique impact culturally responsive social and emotional learning (SEL) can have in this population. In addition, we provide models and examples on how school-based interventions can be implemented in a transformative manner for this vulnerable population, highlighting implications for researchers and practitioners to better collaborate with the LYOI community.

Purpose – This chapter discusses the promise of and challenges to providing effective and culturally responsive trauma-focused mental health services to immigrant and refugee youth and their families within school settings.

Design/methodology/approach – This chapter utilizes “practice-based evidence” to outline successes and address the barriers associated with the implementation of school-based, trauma-focused, evidence-based interventions in four immigrant or refugee-dense cities: Los Angeles, Chicago, Minneapolis, and Boston.

Findings – Making cultural adaptations to identified trauma interventions that were consistent with community priorities, cultural norms, and values resulted in more accessible programs and greater engagement in treatment services.

Practical implications – The strategies tested in these real-world settings contribute to the development of culturally competent trauma-informed services for immigrant and refugee youth and their families. Mental health providers and program developers will better understand the need for multilevel engagement strategies and for culturally driven modifications when employing evidence-based programs with immigrant and refugee youth.

Originality/value – This chapter adds to the scarce evidence about useful methods to engage immigrant and refugee youth and families in treatment and to increase the likelihood of positive outcomes.

Health-care professionals working in inpatient forensic mental health settings are exposed to a range of traumatic and distressing incidents with impacts discussed variously as “burnout”, “compassion fatigue”, “secondary trauma stress” and “vicarious traumatisation”. This study aims to explore the short- and long-term psychological and physical health effects of trauma exposure in the workplace for frontline staff in a forensic setting.

Semi-structured interviews were conducted with 14 nursing staff members working in the male personality disorders care stream in a Medium Secure Hospital.

Thematic analysis yielded five themes: categories of trauma; how well-being is impacted; ways of coping and managing; protective factors; and systemic factors, with sub-themes within each of the superordinate themes.

The findings demonstrate that some staff members were affected both physically and psychologically as a result of trauma-focused work whereas other staff members were unaffected. The psychological and physical health effects were broadly short-term; however, long-term effects on staff member’s social networks and desensitisation to working conditions were observed. A broad range of coping methods were identified that supported staff member’s well-being, which included both individual and organisational factors. Staff member’s health is impacted by exposure to workplace trauma either directly or indirectly through exposure to material, and there is a greater need to support staff members after routine organisational provisions are complete. Staff should receive education and training on the possible health effects associated with exposure to potentially traumatic material and events.

This research has further contributed to understanding the staff needs of nursing staff members working with the forensic personality disorder patients within a secure hospital setting. This research has identified the following service developments: the need for ongoing support particularly after organisational provisions are complete; further prospects to engage in psychological formulations; greater opportunities for informal supervision forums; staff training to understand the potential health impact associated with trauma-focused work; supervisors being appropriately trained and supported to elicit impacts of trauma-focused work on staff members; and additional opportunities to discuss well-being or monitor well-being.

The purpose of this paper is to present insights into how and why the Sanctuary and SELF models are effective in decreasing trauma symptoms with a population of court-committed male adolescents in a residential treatment program. The Sanctuary model is a trauma-focussed, trauma-sensitive, organizational change model, and treatment protocol approach to working with clients who have experienced trauma, loss, and toxic stress to the degree that they interfere with social and personal functioning. The SELF model within Sanctuary is a treatment protocol that is an acronym for the organizing categories of safety, emotion management, loss, and the future. In essence, Sanctuary’s purpose is to create therapeutic community.

Qualitative research methods of observation of groups and meetings, content analysis of existing quantitative data and agency documents, focus groups with staff and residents, and individual interviews with staff were utilized.

Data show that the Sanctuary model ameliorates the symptoms of complex trauma. The substantive theory that emerges is that relational and neurological integration and recovery occur in the lives of residents as shaped first by the therapeutic community that supports the level of interpersonal relationships experienced with staff within a therapeutic milieu, along with shaping the organizational culture.

As a complex intervention, it is evident that reducing the Sanctuary model into its component parts cannot capture fully the essence of the intervention. A complex system can never be understood fully by observing it at single points in time.

It is suggested that future research and programmatic planning within this therapeutic community need to demonstrate how to continue enhancing staff-resident relational integration vis-à-vis staff training and vehicles that offer residents more of a representative voice while in placement.

It is suggested that future research and programmatic planning within this agency need to demonstrate how to continue enhancing staff-resident trauma-informed therapeutic milieus and relational integration vis-à-vis staff training and vehicles that offer residents more of a representative voice while in placement.

This is a unique study in that it employs qualitative methods to explore how and why the Sanctuary model contributes to its working in a residential treatment facility. The Sanctuary model is the only trauma-informed organizational intervention of its kind, with limited published evaluations in the current literature (Esaki et al., 2013). This study used focus groups with residents and staff that allowed them to influence the research and its processes. The residents expressed their views about the experience of being placed outside of their homes and of living in a therapeutic community within the Sanctuary Network. Staff spoke of aspects of working in a trauma-informed milieu and its effect on clients, colleagues, and the organization as a whole.

Trauma-focussed cognitive-behaviour therapy (TF-CBT) is the most effective treatment for post-traumatic stress disorder (PTSD). Individuals who present with complex PTSD are among the most complex and challenging patients seen by intellectual disability psychology and psychiatry services. The purpose of this paper is to study TF-CBT intervention for people with intellectual disabilities and complex PTSD.

Three groups of adults with intellectual disabilities (ID) presenting with complex PTSD (n=3, n=5 and n=4) were treated using a 12-week manualised intervention adapted from a procedure routinely used in adult mental health services. Participants completed the Impact of Event Scale as adapted for people with intellectual disabilities (IES-ID) before and after the intervention, and interviews conducted to ascertain their experiences of the group were analysed using interpretative phenomenological analysis (IPA).

The ten participants who completed the intervention showed a 27 per cent decrease in median Impact of Event Scale Intellectual Disabilities scores, equivalent to a medium effect size (d=0.50). Five themes were identified from the interviews: being listened to; it is nice to know you are not the only one; being in a group can be stressful; the importance of feeling safe; achieving and maintaining change. Participants also provided constructive feedback to promote improvements to the manual.

A feasibility study followed by methodologically robust clinical trials is now needed to establish the effectiveness of the intervention and its utility in clinical practice.

This small study has confirmed the potential of TF-CBT as an intervention for extremely vulnerable individuals with ID who present with complex PTSD.

The findings indicate that a group intervention is both feasible for and acceptable to adults with ID.

To date, no study has investigated the effectiveness and feasibility of a TF-CBT group intervention for adults with mild ID.

Human Givens (HG) Rewind technique is a graded trauma-focused exposure treatment for post-traumatic stress disorder and trauma. The purpose of this paper is threefold: first, to describe the technique; second, to provide an outline of its potential benefits; and third, to present some preliminary evidence.

This paper provides an overview of HG therapy and describes the stages of HG Rewind trauma treatment and its potential benefits. Similarities and differences between Rewind and other Cognitive Behavioural Therapy techniques are explored. Possible underlying mechanisms are discussed.

Preliminary evidence suggests that Rewind could be a promising trauma treatment technique and that HG therapy might be cost effective. The findings highlight the need for further research and a randomised controlled trial (RCT) on Rewind is warranted.

During the rewind technique, the trauma does not need to be discussed in detail, making treatment potentially more accessible for shame-based traumas. Multiple traumas may be treated in one session, making it possible for treatment to potentially be completed in fewer sessions.

This UK-based treatment may be cost effective and make treatment more accessible for people who do not want to discuss details of their trauma.

This is the first description of HG Rewind in the peer-reviewed literature. Alternative explanations for mechanisms underlying this trauma treatment are also presented.

In the previous chapter, the reader will have become familiar with the idea of screening for traumatic experiences within organisations as a way to identify those who may benefit most from interventions and support. In this chapter, I present an overview of the trauma therapy literature in the first instance and then explore some of the debates regarding specific trauma-informed treatments versus general therapeutic approaches. The multicultural competency literature is discussed, and the multicultural orientation approach of cultural humility, cultural opportunity and cultural comfort is highlighted in a practice context. This chapter concludes with a case study vignette that brings it all together with a clinical example of what trauma-informed therapy through a multicultural lens might look like. As such I operationalise choice, collaboration , trust and transparency, and cultural principles from the trauma-informed care literature. Although applied here to specific trauma-informed organisations, some of the methods and processes that I unpack can be used in non-specific organisations where social/case managers are employed and wish to operationalise choice and collaboration in a structured way.

People with intellectual disabilities are at a significantly higher risk than the general population for experiencing a wide range of adverse and potentially traumatic events. This paper aims to explore the incidence of experiences of lifetime trauma across this population in one Forensic Intellectual Disability Service. Risk management recommendations and psychological risk formulations were also examined for their consideration of traumatic experiences.

Risk assessment reports (n = 39) were reviewed for evidence of traumatic experiences and the consideration of trauma in patient risk formulations and risk management treatment recommendations.

Trauma was rated as present or partially present in 84.6% (n = 33) of risk assessment reports reviewed. None of the patients had received a post-traumatic stress disorder (PTSD) diagnosis. Recommendations regarding trauma were identified in 39.4% (n = 13) of the risk assessment reports where trauma was rated either “present” or “partially present”.

Findings suggest a need for diagnostic tools to be used to measure trauma symptoms and potential cases of PTSD to best support needs of patients. Trauma-focused interventions should also be considered. Further investigation is needed to clarify the disparity between the consideration of trauma in formulations and treatment recommendations.

This study highlights the different traumatic experiences that forensic patients across three settings have been exposed to during their lifetimes.

In support of the national requirement “to ensure that Scotland has a workforce that is fully aware of the impact of trauma, and is equipped to respond appropriately to people who have experienced trauma at any age”, Trauma Awareness Training was delivered to various public sector organisations across Dumfries and Galloway. Research has shown that trauma can significantly impact quality of life (Svanberg, Bonney and McNair, 2011; Bentall et al., 2014). A trauma-informed practice workshop was created and evaluated in response to a need for training within public services for individuals working with clients whom have experienced trauma.

From May 2018 to December 2019, 10 one-day Trauma-Awareness Training courses were delivered, engaging 224 public service workers from Police Scotland, Scottish Fire Service, Relationship Scotland, Shelter Scotland and DandG Council staff working with trauma-experienced individuals. The training was delivered via PowerPoint, short videos, whiteboard explanations/drawings and case examples. The morning workshop concentrated on defining psychological trauma, understanding the psychological process of Post-Traumatic Stress Disorder (PTSD) and the subsequent consequences. The afternoon session focussed primarily on complex PTSD, the role of adverse childhood experiences, attachment and emotional regulation/dysregulation and trauma-focused working with the wider multi-disciplinary workforce. The training concluded with participants developing strategies for coping with trauma. Participants were asked to complete three questionnaires: pre-training questionnaire on perceived knowledge of trauma and delivering trauma practice. Post-training questionnaire on perceived knowledge of trauma and delivering trauma practice to assess change and training evaluation. A third questionnaire was issued seven months after training to establish the impact of training on practice.

Findings evidence a positive impact on person-centred care. In terms of quality improvement, participants felt: The training was relevant across services and raised awareness of the importance of trauma-informed practice. They had a greater awareness of trauma-related issues with individuals. Confident in implementing learned skills to assist those who have experience of trauma. They could build better relationships with their service users, with patients feeling more understood.

Project findings identified a need for multi-organisational working and consultancy from psychological services to improve access to services. Ultimately, brief trauma-awareness training for staff can lead to more positive experiences for patients.